
GopyrightlJ? 



JO 



III 

1 



COPYRIGHT DEPOSIT. 



VETERINARY PRACTITIONERS' SERIES 

NO. 1 



LAMENESS of the HORSE 



BY 



J. V. Lacroix, D. V. S. 

Professor of Surgery, The Kansas City Veterinary College 
Author of "Animal Castration" 



Illustrated 



Chicago 

AMERICAN JOURNAL OF VETERINARY MEDICINE 

1916 






Copyright, 1916 

By 

D. M. CAMPBELL 




NOV i3l9:6 
©CI.A4463;i'^ 



PREFACE 

AH that can be known on the subject of lameness, is founded 
on a knowledge of anatomy and of the physiology of locomotion. 
Without such knowledge, no one can master the principles of 
the diagnosis of lameness. However, it must l)c assumed that 
the readers are informed on these subjects, as it is impossible 
to include this fundamental instruction in a work so brief as 
this one. 

The technic of certain operative or corrective procedures, has 
been described at length only where such methods are not gener- 
ally employed. Where there is no departure from the usual 
methods, treatment that is essentially within the domain of sur- 
gery or practice is not given in specific detail. 

Realizing the need for a treatise in tlie English language 
dealing with diagnosis and treatment of lameness, the author 
undertook the preparation of this manuscript. That the dif- 
ficulties of depicting by means of word-pictures, the symptoms 
evinced in baffling cases of lameness, presented themselves m 
due course of writing, it is needless to say. 

It is hoped that this volume will serve its readers to the end 
that the handling of cases of lameness will become a more satis- 
factory and successful part of their work ; that l)oth the prac- 
titioner and his clients may profit thereby ; and last but by no 
means least, that the horse, which has given such incalculable 
service to mankind and is deserving of a more concrete reward, 
will be benefited by the application of the principles herein out- 
lined. 

In addition to the consultation of standard works bearing on 
various phases of the subject of lameness, the author wishes to 
thankfully acknowledge helpful advice and assistance received 
from the publisher. Dr. D. M. Campbell ; to appreciatively credit 
Drs. L. A. Merillat, A. Trickett and F. F. Brown for valuable 
suggestions given from time to time. Particular acknowledg- 
ment is made to Dr. Septimus Sisson, author, and W. B. Saini- 
ders & Co., publishers of The Anatomy of Domestic Animals, 
for permission to use a num])er of illustrations from that work. 

J. V. L. 

Chicago, Illinois, October, 1916. 



Justice shows a triumphant face at the works of 
humane practitioners, who give serious thought 
and expend honest effort, for the alleviation of 
animal suffering. 



TABLE OF CONTENTS 

Page 

Illustrations ' 

Introduction ^^ 

SECTION I 

Etiology and Occurrence 1^ 

Affections of Bones 1^ 

Rarefying Osteitis, or Degenerative Changes 16 



Fractures 



16 



Affections of Ligaments 20 

Luxations — Dislocations 21 

Arthritis 22 

Affections of Bursae and Thecae 27 

Affections of Muscles and Tendons 28 

Affections of Nerves ^0 

Affections of Blood Vessels 31 

Affections of Lymph Vessels and Glands 32 

Affections of the Feet 34 

SECTION II 

Diagnostic Principles 37 

Anamnesis "^^ 

Visual Examination 39 

Attitude of the Subject 41 

Examination by Palpation 43 

Passive Movements 47 

Observing the Character of the Gait 48 

Special Methods of Examination 53 

SECTION III 
Lameness in the Fore Leg 

Anatomo-Physiological Review of Parts of the Fore Leg 55 

Shoulder Lameness "1 

Fracture of the Scapula ^2 



Page 

Sc;i|)iil()luiiiici';il A ft 1 iritis 65 

Infectious Aitliritis Hfi 

Iiijiirios 66 

Wounds 67 

Luxiilion of tlu' Sc;i])uloliuiii('i-;il .loiiit 67 

Intljiiiiniation of the liicipital Bursa 68 

Contusions of the Triceps Braohii 71 

Shoulder Atrophy (Sweeny) 73 

Paralysis of the Suprascapular Xcrve 75 

Radial Paralysis 77 

Tlironibosis of the Brachial Artery 81 

Fracture of the Humerus 82 

Inflammation of the Elbow 84 

Fracture of the Ulna 86 

Fracture of the Radius 87 

Wounds of the Anterior Brachial Region 90 

Inflammation and Contraction of the Carpal Flexors 93 

Fracture and Luxation of the Carpal Bones 96 

Carpitis 98 

Open Carpal Joint 100 

Thecitis and Bursitis 104 

Fracture of the ^[etacarpus 106 

Splints 107 

Open Fetlock Joint 110 

Phalanjreal Exostosis (Rinp:bone) 118 

Open Sheath of the Flexors of the Phalanges 124 

Luxation of the Fetlock Joint 125 

Sesamoiditis 127 

Fracture of the Proximal Sesamoids 128 

Inflammation of the Posterior Ligaments of the Pastern. 

Proximal Intc^rphalajijnfeal Joint 129 

Fracture of the First and Second Piuilanges ..131 

Tendinitis (Inflammation of the Flexor Tendons) 135 

Chronic Tendinitis and Contraction of the Flexor Tendons. ...137 

Ccmtracted Tendons of Foals..^ 143 

Rupture of the Flexor Tendons and Susj^ensory Ligament ..146 
Thecitis and Hui-sitis in the Fetlock Region 150 



Page 

Arthritis of the Fetlock Joint 152 

Ossification of the Cartilages of the Third Phalanx 155 

Navicular Disease 1'^' 

Laminitis 1^^' 

Calk Wounds (Paronychia) 1''^^ 

Corns IJ^ 

Quittor l'^^ 

ITS 
Nail Punctures - ..--lio 

SECTION IV 

Lameness in the Hind Leg 

Anatomo-Physiological Consideration of the Pelvic Limbs.. .185 

Hip Lameness 1^'^ 

Fractures of the Pelvic Bones 196 

Fractures of the Femur 199 

Luxation of the Femur 201 

Gluteal Tendo-Synovitis 203 

Paralysis of the Hind Leg 204 

Paralysis of the Femoral (Crural) Nerve 20-i 

Paralysis of the Obturator Nerve 206 

Paralysis of the Sciatic Nerve -.- 208 

Iliac Thrombosis - 209 

Fracture of the Patella 212 

Luxation of the Patella..... 213 

Chronic Gonitis 217 

Open Stifle Joint - 220 

Fracture of the Tibia 222 

Rupture and Wounds of the Tendo Achillis 224 

Spring-Halt (String-Halt) 225 

Open Tarsal Joint 229 

Fracture of the Fibular Tarsal Bone (Calcaneum) 230 

Tarsal Sprains 232 

Curb 233 

Spavin (Bone Spavin) 235 

Distension of the Tarsal Joint Capsule (Bog Spavin) 242 

Distension of the Tarsal Sheatli of the Deep Digital Flexor 

(Thoroughpin) 246 



Page 

Capped Hock 251 

Rupture and Division of the Lonp: Difjitnl lOxtensor (Ex- 
tensor Pedis) 253 

Wounds from Interfering 255 

Lymphangitis 257 

Authorities Cited 265 

Index 267 



ILLUSTRATIONS 

j Page 

Fig. 1 Hoof Testers 53 

Fig. 2 — Muscles of Left Thoracic Limb, Lateral View 56 

Fig. 3 — Muscles of Left Thoracic Limb, Medial View 57 

Fig. 4 — Sagital Section of Digit and Distal Part of Meta- 



carpus 



59 



Fig. 5 — Ordinary Type of Heavy Sling 62 

Fig. 6— A Sling Made in Two Parts 63 

Fig. 7 — Paralysis of the Suprascapular Nerve of Left 

Shoulder 76 

Fig. 8 — Radial Paralysis - 78 

Fig. 9 — Merillat's Method of Fixing Carpus in Radial 

Paralysis 79 

Fig. 10 — Contraction of Carpal Flexors, "Knee Sprung".... 95 
Fig. 11 — Pericarpal Inflammation and Enlargement Due to 

Injury 99 

Fig. 12 — Hygromatous Condition of the Right Carpus 100 

Fig. 13 — Carpal Exostosis in Aged Horse 101 

Fig. 14 — Exostosis of Carpus Resultant from Carpitis 102 

Fig. 15 — Distal End of Radius, Illustrating Effects of 

Carpitis 102 

Fig. 16 — Posterior View of Radius, Illustrating Effects of 

Splint 108 

Fig. 17 — Phalangeal Exostoses : 120 

Fig. 18 — Rarefying Osteitis in Chronic Ringbone 121 

Fig. 19 — Phalangeal Exostoses in Chronic Ringbone.... 122 

Fig. 20 — Contraction of Superficial Digital Flexor Tendon 

Due to Tendinitis 138 

Fig. 21 — Contraction of Deep Flexor Tendon Due to 

Tendinitis 139 

Fig. 22 — Chronic Case of Contraction of Both Flexor Ten- 
dons of the Phalanges 140 

Fig. 23 — Contraction of Superficial and Deep Flexor Ten- 
dons 141 



I'agc 
Fijr. 24 — Coiitraotion of Superficial Digital Flexor and 

Sliglit Contraction of Deep Plexor Tendon 142 

Fig. 25— ''Fish Knees" 145 

Fig. 26— Extreme Dorsal Flexion 146 

Fig. 27— A Good Style of Shoe for Bracing the FetlocU 148 

Fig. 28— The Roberts Brace in Operation 149 

Fig. 29— Distension of Theca of Extensor of the Digit 151 

Fig. 30 — Rarefying Osteitis Wherein Aiticular Cartilage 

Was Destroyed 153 

Fig. 31 — Ringbone and Sidebone 156 

Fig. 32 — Position Assumed by lIoi-S(> Having I'liilateral 

Navicular Disease 159 

Fig. 33 — The Hoof in Chronic Laminitis 165 

Fig. 34— Effects of Laminitis 166 

Fig. 35 — Cochran Shoe, Inferior Surface 168 

Fig. 36 — Cochran Shoe, Superior Surface 169 

Fig. 37 — Hyperplasia of Right Forefoot Due to Chronic 

Quittor 176 

Fig. 38— Clironic Quittor, Left Hind Foot 177 

Fig. 39— Skiagraph of Foot 179 

Fig. 40— Sagital Section of Right Hock 186 

Fig. 41— :\ruscles of Right Leg; Front View 187 

Fig. 42— :Muscles of Lower Part of Thigh, Leg and Foot 189 

Fig. 43— Right Stifle Joint; Lateral View 190 

Fig. 44— Left Stifle Joint; :\Iedial View 191 

Pig. 45— Left Stifle Joint; Front View 193 

Fig. 46 — Oblique Fracture of the Fenuir 200 

Fig. 47 — Fracture of Femur After Six Months' Treatment..201 
P'ig. 48 — Aorta and Its Branches Showing Location of 

Thrombi 210 

Fig. 49 — Thrombosis of the Aorta, lliacs and Branches 211 

Fig. 50— Chronic Gonitis 218 

Fig. 51 — Position Assumed in Gonitis 219 

Fig. 52— Spring-halt 226 

Fig. 53— Lateral View of Tarsus Showing Effects of Tar- 

sitis 228 

Fig. 54— Right Hock Joint 231 

Fig. 55 — Spavin 235 



Page 

Fig. 56— Bog Spavin 243 

Fig. 57 — Thoroiighpin 247 

Fig. 58 — Fibrosity of Tarsus in Chronic Thoroughpin 248 

Fig. 59 — Another View of Case Shown in Fig. 58 249 

Fig. 60— "Capped Hock" 252 

Fig. 61 — Chronic Lymphangitis 258 

Fig. 62— Elephantiasis 259 



INTRODUCTION 

Lameness is a symptom of an ailment or affection and is not 
to be considered in itself as an anomalous condition. It is the 
manifestation of a structural or functional disorder of some part 
of the locomotory apparatus, characterized by a limping or halt- 
ing gait. Therefore, any affection causing a sensation and 
sign of pain which is increased by the bearing of weight upon 
the affected member, or by the moving of such a distressed part, 
results in an irregularity in locomotion, which is known as lame- 
ness or claudication. A halting gait may also be produced by 
the abnormal development of a member, or by the shortening of 
the leg occasioned by the loss of a shoe. 

For descriptive purposes lameness may be classified as ti-ue and 
false. True lameness is such as is occasioned by structural or 
functional defects of some part of the apparatus of locomotion, 
such as would be caused by spavin, ring-bone, or tendinitis. False 
lameness is an impediment in the gait not caused by structural 
or functional disturbances, l)ut is brought on by conditions such 
as may result from the too rapid driving of an unbridle-wise 
colt over an irregular road surface, or by urging a horse to trot 
at a pace exceeding the normal gait of the animal's capacity, 
causing it to "crow-hop" or to lose balance in the stride. The 
latter manifestation might, to the inexperienced eye, simulate 
true lameness of the hind legs, but in reality, is merely the re- 
sult of the animal having lieen forced to assume an al^normal pace 
and a lack of balance in locomotion is the consequence. 

The degree of lameness, though variable in different instances, 
is in most cases proportionate to the causative factor, and this 
fact serves as a helpful indicator in the matter of establishing a 
diagnosis and giving the prognosis, especially in cases of some- 
what unusual character. An animal may be slightly lame and 
the exhibition of lameness be such as to render the cause baf- 
flingly obscure. Cases of this nature are sometimes quite diffi- 
cult to classify and in occasional instances a positive diagnosis 
is impossible. Subjects of this kind may not be sufficiently in- 



eouvenieneed to warrant their liciiif:? taken ont of service, yet a 
lame horse, no matter how slightly affected, sliould not be con- 
tinued in service unless it can he positively established that the 
degree of discomfort occasioned by the claudication is small and 
the work to be done by th(> animal, of the sort that will not 
aggravate the condition. 

Subjects that are very lame — so lame that little weight is 
l)orne by the affected member — are, of course, unfit for service 
and as a rule are not difficult of diagnosis. For instance, a frac- 
ture of the second phalanx would cause much more lameness than 
an injury to the lateral ligament of the coronary joint wherein 
there had occurred only a slight sprain, and though crepitation 
is not recognized, the diagnostician is not justified in excluding 
the possibility of fracture, if the lameness seems disproportion- 
ate to the apparent first cause. 

The course taken by cases of lameness is as variable as the 
degree of its manifestation, and no one can definitely predict the 
duration of any given cause of claudication. 

liecause of the fact that horses are not often good self-nurses 
at best, and that it is difficult to enforce proper care for the parts 
affected, one can not wisely state that resolution will promptly 
follow in an acute involvement, nor can he predict that the case 
will or will not become chronic. Experience has proved that 
complete or partial recovery may result, or again, that no change 
may occur in anj'- given case, and that in some instances even 
where rational treatment is early administered, a decided aggra- 
vation of the condition may follow unaccountably. 

However, because of the economic element to be reckoned with, 
it is of some value to be able to give a fairly accurate prognosis 
in the handling of cases of lameness, as in the majority of in- 
stances the treatment and manner of after-care are determined 
largely by the expense that any prescribed line of attention will 
occasion. 

A ca.se of acute bone spavin in a horse of little value is not 
generally treated in a manner that will incur an expense equiva- 
lent to one-half the value of the subject. The fact is always to 
be considered in such cases, that even where ideal conditions favor 
proper treatment, the outcome is uncertain. Where less than 



six weeks of rest can be allowed the animal, one affected with 
bone spavin would therefore not be treated with the expectation 
of obtaining good results, as six weeks' time, at least, is necessary 
for a successful outcome. If the cost attending the enforced 
idleness of an animal of this kind is considered prohibitive for 
the employment of proper measures to affect a cure, and if lame- 
ness is slight, the animal should be given suitable work, but in 
cases of articular spavin in aged subjects, they should be hu- 
manely destroyed and not subjected to prolonged misery. 

A thorough knowledge of the structure and functions of the 
affected parts is necessary to proceed in cases of lameness ; like- 
wise, the age, conformation and temperament of the subject need 
to be taken into consideration ; the presence or absence of com- 
plications demand the attention; the kind of care the sul)ject 
will probably receive directly influences the outcome ; and the 
character of service expected of the subject, too, needs to be 
carefully considered before the ultimate outcome may reasonably 
be foretold. 

The practitioner is often confronted with the problem of how 
best to handle certain cases. Will they do better under condi- 
tions where absolute quiet is enforced, or is it preferable to allow 
exercise at will? The temperament of the animal must be con- 
sidered in such cases, and if a lame horse is too active and play- 
ful when given his freedom, exercise must be restricted or pre- 
vented, as the ease may require. In cases of strains of tendons, 
during the acute stage, immobilization of the affected parts is in 
order. In certain sub-acute inflammatory processes or in in- 
stances of paralytic disturbance where convalescence is in prog- 
ress, moderate exercise is highly beneficial. 

Consequently, each case in itself presents an individual prob- 
lem to be judged and handled in the manner experience has 
taught to be most effective, appropriate and practical, and the 
veterinarian should give due consideration to the comfort and 
welfare of the crippled animal as well as to the interests of the 
owner. 



SECTION I. 
ETIOLOGY AND OCCURRENCE. 

In discussions of pathological conditions contiibnting to lame- 
ness in the horse, cause is generally classified under two heads — 
predisposing and cxciiing. It becomes necessary, however, to 
adopt a more general and comprehensive method of classification, 
herein, which will enable the reader to obtain a better conception 
of the subject and to more clearly associate the parts so grouped 
descriptively. 

Though predisposing factors, such as faulty conformation, are 
often to be reckoned with, exciting causes predominate more fre- 
quently in any given number of cases. The noble tendency of 
the horse to serve its master under the stress of pain, even to 
the point of complete exhaustion and sudden death, should win 
for these Avilling servants a deeper consideration of their welfare. 
Too frequently are their manifestations of discomfort allowed 
to pass unheeded by careless, incompetent drivers lacking in a 
sense of compassion. Symptoms of malaise should never be 
ignored in any case; the humane and economic features should 
be realized by any owner of animals. 

In the consideration of group causes, lameness may be said 
to originate from affections of bones, ligaments, thecae and bur- 
sae, muscles and tendons, nerves, lymph vessels and glands, and 
blood vessels, and may also result from an involvement of one or 
several of the aforementioned tissues, caused by rheumatism. 
Further, affections of the feet merit separate consideration, and, 
finally, a miscellaneous grouping of various dissimilar ailments, 
which for the most part, do not directly involve the locomotory 
apparatus but do, by their nature, impede normal movement. 

AFFECTIONS OF BONES. 

The bony colunni serving as the framework and support of 
the legs, probably constitutes the most vital element having to 
do with weight bearing and locomotion, and therefore during 
the acute and painful stage 'of bone affections, the pain becomes 

15 



16 LAMENESS OF THE HORSE 

iiiorc intense in the prueess ami pressure of standing than when 
the member is swung or advanced. 

Certain bones are so well protected by muscular structures 
that they are not frequently injured except as a result of vio- 
lence which may produce fracture. However, there are certain 
bones which receive the constant shock of concussion when the 
animal is subjected to daily, rapid work on hard road surfaces. 
Splints, ringbones and spavins are the most general examples 
produced by these conditions. 

Varying pathological developments often result from concus- 
sion, contusion or other violent shocks to the bony structures. 
In such cases there either follows a simple periostitis which may 
resolve spontaneously with no obvious outward symptom, or 
osteitis, which may occur with tissue ciianges, as in exosto.sis; or 
the case may produce any degree of reaction between these two 
possible extremes. 

Rarefying Osteitis, or Degenerative Changes. 

Certain bone affections, such as osteomalacia or osteojiorosis, 
are in the main, responsible for distortions and morphological 
changes of bone, causing lameness, permanent blemish and even 
resulting in death of the affected animal. The climatic condi- 
tions in some localities favor these occurrences but they may 
also be ascribed to improper food constituents and to possible 
infective agencies. 

Rarefying degenerative changes manifested by exostosis involv- 
ing the phalanges of the young, causing ringbone, are fairly com- 
mon in occurrence throughout this country. This is due. sup- 
posedly, to a lack of mineral substance in the bony structure of 
the affected animals, and is known as rachitis — connnonly called 
rickets. Since the affected subjects suffer involvement of several 
of the extremities at the same time, the theory of rachitic origin 
seems well supported. 

Fractures. 

Fractures of bones constitute serious conditions and are always 
manifested bv lameness. A sub-classification is essential here 



ETIOLOGY AND OCCURRENCE 17 

for the student of veterinary medicine who would comprehend 
the technic of reduction and subsequent treatment in such 
cases. 

Fractures are classified b}^ many authorities as being simple, 
compound, and comminuted. This method is practical because 
it separates dissimilar conditions. There are also grouped frac- 
tures, the pathologic anatomy of which is similar. Classification 
on an etiological basis would attempt to associate conditions, 
the morbid anatomy and gravity of which would justlj^ preclude 
their being combined. 

Simple Fracture is a condition where the continuity of the 
bone has been broken without serious destruction of the soft 
structures adjacent, and where no opening has been made to the 
surface of the flesh. Such fractures do not reduce the bone to 
fragments. Long bones are frequently subjected to simple frac- 
ture, while short thick bones, such as the second phalanx, may 
suffer multiple or comminuted fractures. 

Compound Fracture designates a break of l)one with the 
destruction of the soft tissues covering it, making an open wound 
to the surface of the skin. This form of fracture is serious 
because of the attendant danger of infection, and in treatment, 
necessitates special precaution being taken in the application of 
splints that the wound may be cared for without infection of the 
tissues. These fractures generally occur as a result of some 
forceful impact through the flesh to the bone, or where the bones 
are driven outward by the blow. Common examples are in frac- 
tures of the metacarpus and metatarsus of the first phalanx. 
This kind of injury in mature horses usually produces an ir- 
reparable condition, and viewed economically, is generally con- 
sidered fatal. 

Comminuted Fractures, as the term implies, are those cases 
wherein the bone is reduced to a number of small pieces. This 
kind of break may be classified as simple-comminuted fracture 
when the skin is unbroken, and Avhen the bone is exposed as a 
result of the injury, it is known as a compound-comminuted 
fracture. Such fractures are caused by violent contusion or 
where the member is caught between two objects and crushed. 



18 LAMENESS OF THE HORSE 

Multiple Fractures. 

Fractures are called multiple when the hone is reduced to a 
nunil)er of pieces of large size. This condition differs from a 
comminuted fracture in that the multiple fracture may break 
the bone into several pieces without the pieces being ground or 
crushed, and the affected bone may still retain its normal shape. 

Further classification is of value in describing fractures of 
bone with respect to the manner in which the bone is broken — 
the direction of the fissure or fissures in relation to its long 
axis. 

A fracture is transverse when the bone is broken at a right 
angle from its long axis. Such breaks when simple, are the least 
trouble to care for because there is little likelihood that the 
broken ends of bone will become so displaced that they will not 
remain in apposition. Simple transverse fracture of the meta- 
carpus, for instance, constitutes a favorable case for treatment 
if other conditions are favorable. 

Oblique fractures, as may be surmised, are solutions of con- 
tinuity of bone in such manner that the fissure crosses the long 
axis of a bone at an acute or obtuse angle. These fractures are 
prone to injure the soft structures adjacent, and are frequently 
compound, as well. ^Moreover, because of the fact that the ap- 
posing pieces of bone are beveled, the broken ends of bone are 
likely to pass one another in such a way as to shorten the dis- 
tance between the extremities of the injured member. Con- 
traction of muscles also tends to exert traction upon a bone so 
fractured, resulting in a lateral approximation of the diaphysis 
and thus preventing union because the broken surfaces are not 
in proper contact. 

Fractures arc longitudinal when the fissure is parallel with 
the long axis of the bone. This variety of break is not infre- 
quent in the first phalanx ; and a vertical fracture of the second 
j)halanx is also said to be longitudinal, however, there is little 
difference (if any, in some subjects) between the vcMtic.il jind 
transverse diameters of this particular bone. 

Green stick fracfurrs are essentially tiiose resulting from falls 
to young aninuds. They are usually sub-periosteal and when 



ETIOLOGY AND OCCURRENCE 19 

the periosteum is left intact or nearly so, no crepitation is dis- 
cernible. If this fracture is simple, prompt recovery may be ex- 
pected. Bones of young animals, because they do not contain 
proportionately as much mineral substance as do bones of adults, 
are more resilient and less apt to become completely fractured. 
They are, however, subject to what is known as green stick 
fracture. 

Impacted fractures are usually occasioned by falls. When the 
weight of the body is suddenly caught by a member in such man- 
ner as to forcefully drive the epiphyseal portions of bone into 
and against the diaphysis, multiple longitudinal fractures occur 
at the point of least resistance. Parts so affected undergo a 
fibrillary separation, increasing the transverse diameter of the 
bone; or if the impact has been sufficiently violent, the portion 
becomes an amorphous mass. 

In a treatise on the subject of lameness, the bones chiefly con- 
cerned and most often affected must l)e especially considered. 
The shape and size of a bone when injured, determines in a 
measure, the course and probable outcome in most cases, but of 
first and greater importance is the function of the bone. A frac- 
ture of the fibula in the horse need not incapacitate the subject, 
but a til)ial fracture is serious and generally proves cause for 
fatal termination. The body of the scapula may be completely 
fractured and recovery will probably result in most cases without 
much attention being given to the su])ject, yet a fracture of the 
neck of this same bone constitutes an injury of serious conse- 
quence. The difference in the function of different parts of this 
same bone, as well as its shape and mode of attachment, deter- 
mine the gravity of the case ; so it is in fractures of other bones 
with respect to the course and prognosis of the ea.se — function 
is the important factor to be considered. 

Next in importance is the age of the animal suffering fracture 
of the bone. Capacity for regeneration is naturally greater in 
a vigorous, young animal than in aged or even middle-aged sub- 
jects. A healthy condition of the bone and the body favor the 
process of repair in case of fracture, and prognosis may be favor- 
able or unfavorable, depending upon these factors mentioned for 
consideration. Individuals of the same species, differing in tem- 



20 LAMENESS OF THE HORSE 

perament, may comport themselves in a manner that is conductive 
to pn)mpt recovery, or to early destruction. This feature cannot 
be overestimated in importance, as it is sometimes a decisive 
element, regardless of other conditions. A horse suffering from 
an otherwise remediable pelvic fracture may be so worried and 
tortured by being confined in a sling that the case calls for spe- 
cial attention and care because of the animal's temperament. 
Sometimes, the constant presence of a kind attendant will so 
reassure the subject that it will become resigned to unnatural 
confinement, in a day or two. This precaution may, in itself, 
determine the outcome, and the wise veterinarian will not over- 
look this feature or fail to deviate from the usual rote in the 
handling of average cases. Recovery may be brought about in 
irrital)le subjects by this concession to the individual idiosyn- 
crasies of such animals. 

AFFECTIONS OF LIGAMENTS. 

Ligaments which have to do with the locomotory apparatus 
are, for the most part, inelastic structures which are composed 
of white fibrous tissue and serve to join together the articular 
ends of bones ; to bind down tendons ; and to act as sheathes or 
grooves through which tendons pass, and as capsular membranes 
for retention of synovia in contact with articular surfaces of 
bones. 

Ligaments are injured less freciueiitly than are bones. Because 
of their flexibility they escape fracture in the manner that bones 
suffer. They are, however, completdy severed by being cut or 
ruptured, though fibrillary fracture the result of constant or 
intermittent tensile strain is of more frequent occurrence. 

SiTiiple infiannnation of ligaments is of occasional occurrence 
but, unless considerable injury is done this tissue, no perceptible 
manifestation of injury results. No doubt many cases wherein 
fibrillary fracture of ligaments (sprain) takes jilace some lame- 
ness is caused, but because of the dense, comparatively non- 
vascular nature of these structures, little if any manifestation, 
exeejit lameness, is evident. And such cases, if recognized are 
usually diagnosed by excluding the existence of other possible 
causes and conditions which mitrht also cause lameness. 



ETIOLOGY AND OCCURRENCE 21 

Certain ligaments are subjected to strain more than are others 
and therefore, when so involved, frequently cause lameness. Ex- 
amples of this kind are affections of the collateral (lateral) liga- 
ments of the phalanges. Because of the leverage afforded by the 
transverse diameter of the foot, when an animal is made to travel 
over uneven road surfaces, considerable strain is brought to bear 
on the collateral ligaments of the phalanges. A sequel to this 
form of injury is a circumscribed periostitis at the site of at- 
tachment of the ligaments and frequently the formation of an 
exostosis — ringbone — results. 

Where sudden and violent strain is placed upon a ligament 
and rupture occurs, the division is usually effected by the liga- 
ment being torn from its attachment to the bone. In such cases, 
a portion of periosteum and bone is usually detached and thi.' 
condition may then properly be called one of fracture. In some 
cases of this kind recovery is ta.rdy, because of the difficulty 
in maintaining perfect apposition of the divided structures, and 
reactionary inflammation is not of sufficient extent to enhance 
prompt repair. In fact, some cases of this kind seem to progress 
more favorably, when no attempt at innnobilization of the af- 
fected member is attempted. 

If some freedom of movement is allowed, acute inflammation 
resulting in nature's provisional swelling soon develops and 
repair is hastened because of increased vascularity. But where 
luxation of phalanges accompanies sprain, reposition and immo- 
bilization are necessary — that is if cases are thought likely to 
benefit by any treatment. 

^'^ Luxations — Dislocations. 

Luxation or dislocation is a condition where the normal rela- 
tion between articular ends of bones has been deranged to the 
extent that partial or complete loss of function results. When a 
bone is luxated (out of joint), there has occurred a partial or 
complete rupture of certain ligaments or tendons; or a bone 
may be luxated when an abnormal or unusual elasticity of inhib 
itory ligaments or tendons obtains. 

Luxations may be practically classified as temporar)} and fixed. 
In temporary luxations, disarticulation is but momentary and 



22 LAMENESS OF THE HORSE 

spontaneous rei)osition always results; while a fixed luxation does 
not reduce spontaneously Imt remains luxated until reposition 
is effected by j)roper iiuuiipulation and treatment. Fixed luxa- 
tion may ]>e of sudi character a.s to be practically irreducible 
because of extensive danmj?e done to liiraments or cartilacre. 
Where a complete luxation of the metaearpophalanireal joint 
exists, it is probable that in most eases sutificient injury to col- 
lateral and capsulai' li«raments has been done to render com- 
plete recovery improbable, if not impossible. 

Temporary luxation of the patella is a conunon affection of 
the horse and fixed luxation of this bou' also occurs. As a mat- 
ter of fact, in the horse, patellar luxation is the one frequent 
affection of this kind. 

As a rule, complete disarticulation immobilizes the affected 
joint and in most instances there is noticeable an abnormal prom- 
inence in the immediate vicinity — in patellar luxation, the whole 
bone. In other instances the articular portion only, of the af- 
fected bone is malpositioned. Usually, luxation and fracture 
may be differentiated in that there is no crepitation in luxation 
and more or less crepitation exists in fracture. 

It is evident, when one considers the symptomatology and 
nature of the affection, that fixed luxation is usually caused by 
undue strain or violent and abnormal movement of a part. 
Joints having the greater freedom of movement are apt to suffer 
luxation more frequentl5^ 

Arthritis. 

The study of arthritis in the horse is limited to a considera- 
tion of joint inflammations which, for the most part, are of 
traumatic origin. Unlike the human, the horse is not subject 
to many forms of specific arthritis — tubercular, gonorrheal, syph- 
ilitic, etc. 

A practical manner of classification of arthritis is Iraiiiiuilic 
and metastatic. 

Traumatic arnirilis may result fi-oiii .ill sorts of accidents 
wherein joints are contused. Such cases may be considered as 
being caused by direct injuries. Instances of this kind, dej^end- 
ing on the degree of insult, manifest evidence of injury which 



ETIOLOGY AND OCCURRENCE 23 

ranges from a simple synoviti.s to the most active inflammatory 
involvement of tlie entire structure and adjacent tissues. 

The reactionary inflammation which attends a case of tarsitis 
caused by a horse being kicked is a good example of the result 
of direct injury. Such cases, if the contusion is of sufficient 
violence, result in arthritis and periarthritis. In inactive farm 
horses, during cold weather, this condition ])ecomes chronic, swell- 
ing remains for weeks after all lameness and pain have sub- 
sided and occasionally hyperthrophy is permanent. 

Arthritis occasioned by indirect injury, such as characterizes 
joint inflammation from continuous concussion, is seen in horses 
that are worked at a rapid pace on city streets or other hard 
road surfaces. Such affections may be acute, as in some cases 
of spavin, but are usually inflammatory conditions that do not 
occasion serious disturbance when these affections become chronic. 
If the involvement persists with sufficient active inflammation, 
there may follow erosion of cartilage and incurable lameness. 
If extensive necrosis of cartilage takes place, the attendant pain 
will be sufficient to cause the animal to favor the diseased part 
and such immobilization enhances early aukylosis — nature's sub- 
stitute for resolution in this disease. 

Wounds invading the tissues adjacent to joints, when these 
wounds are of considerable extent, cause inflammation of such 
articulations by contiguous extension of inflammation. As long 
as an injury remains practically aseptic, or if infected and the 
septic process does not involve the joint proper by direct ex- 
tension, no more serious disturl)anee than a simple synovitis will 
result. If, instead, a periarthritic inflammation is serious or 
destructive in character, the type of arthritis will be grave — 
even though due to an indirect cause. 

Where a vulnerant body penetrates all structures and invades 
the interior of the joint capsule the result is that a more or less 
active disturbance is incited. The introduction of a sterile in- 
strument into a joint cavity, under strict asepsis, where a per- 
fect technie is executed, does not cause perceptible manifesta- 
tion of the injury, if the opening so nuide is small — such as a 
suitable exploratory trocar makes. Rut a puncture made in a 
similar manner and with the same instrument without due regard 



24 LAMENESS OF THE HORSE 

to asepsis is likely to cause an infectious synovitis and arthritis 
usually follows. 

A larger oi)ening than is produced by iiicajis of an exploratory 
trocliar may be made into a joint cavity, causing escape of syn- 
ovia as it is secreted for days and even for weeks and no serious 
or permanent trouble is experienced in some cases. If the syn- 
ovitis or arthritis remains non-infected and the Avound, trau- 
matic or surgical, is not too large, healing by granulation 
occurs, and the discharge of synovia ceases. However, if synovial 
discharge persists too long because of tardy closure of an open 
joint, there is great danger of infection gaining entrance into 
the synovial cavity, or in some instances, desiccation of endo- 
thelial cells of the articulation occurs, in areas, and the reaction- 
ary iiitianuuation eventually results in ankylosis. 

A small puncture which introduces into the synovial cavity 
infectious material of active virulence will cause an arthritis 
that is more serious, much more painful and more difficult to 
handle than is occasioned by a wound of moderate size, that 
ad'ords ready escape of synovia even through the virulence of 
the infection be the same. 

Synovia is a good culture medium and the environment is 
ideal for multiplication of bacteria; consequently, the grave 
disturbances which may attend the introduction of pathogenic 
organisms into a synovial cavity as the result of a puncture 
wound are not to be forgotten. The veterinarian is in no position 
to estimate the virulency of organisms so introduced ; neither 
can he determine the exact degree of resistance passessed by the 
subject in any given case. Therefore, he is uncertain as to the 
best method of handling such cases where an injury has been 
recently inflicted and positive evidence of the existence of an 
infectious synovitis is not present. If one could determine in 
advance the degree of infection and injury that is to follow small 
penetrant wounds of joint capsules, it would then be possible 
to select certain cases and immediately drain away all s^Tiovia 
and fill the cavity by injection with suitable antiseptic solutions. 
This offers a broad field for experimentation which will in 
time be i)roductive of a radical change in the manner of treating 
such cases. 



ETIOLOGY AND OCCURRENCE 25 

Metastatic arthritis is seen more frequently in colts or young 
animals than in mature horses and we here take the liberty of 
classifying- with the arthritis of omphalophlel>itis and strangles 
the so-called rheumatic variety. 

A specific polyarthritis or synovitis which attends navel in- 
fection of foals is perhaps the most frequent form of arthritis 
that is to be considered metastatic. This condition is truly a 
disease of young animals and, while it is a specific arthritis, 
the cause is yet to be attributed to any definite pathogenic organ- 
ism with certainty. This condition is well defined by Bollinger 
as quoted by Hoare/ when he calls it a purulent omphalophle- 
bitis due to local infection of the umbilicus and umbilical ves- 
sels, by pyogenic organisms, causing a metastatic pyemia. 

This affection is grave; its course is comparatively brief; the 
prognosis is usually unfavorable ; and omphalophlebitis occa- 
sions a form of lameness which at once impresses the practi- 
tioner that serious constitutional disturbance exists. Its con- 
sideration properly belongs to discussions on practice or obstet- 
i-ics and diseases of the new born, and it has received careful 
attention and is discussed at length in these works. 

A second form of metastatic arthritis is met with in strangles. 
Strangles occurs in the young principally and is not a frequent 
cause of synovitis or arthritis in the adult animal. 

Strangles or distemper is, according to most pathologists, due 
to the Streptococcus equi. Hoare- states that in this type of 
specific arthritis the contagium is probably carried by the blood. 
He gives it as his opinion that even laminitis has occurred as 
a result of the streptococcus-equi. This, indeed, would point 
toward probable extension by the blood as well as by way of 
lymph vessels. 

Septic synovitis and infectious arthritis are always serious af- 
fections even in young animals and much depends upon indi- 
vidual resistance and early rational treatment in such cases, if 
recovery is to follow. 

The same general plan of treatment is indicated in this kind 
of septic sj^novitis as is employed in all cases of infective syn- 



^A System of Veterinary Medicine by E. Wallis Hoare, F. R. C. V. S., Vol. 1, 
page 510. 
-Ibid, page 807. 



26 LAMENESS OF THE HORSE 

ovitis and st'jilic infection in open joints. Thci'c is to ht- consid- 
ered, however, the fact that the yonn«r animal is more ajjile, a 
l)etter self-nurse, and in a ^enei-al way more apt to reeover than 
is the adult, under similar conditions. 

Iih( iimalif (irtlirilis, if one is justified in classifying rheumatic 
intlannnation of joints as a metastatic form of arthritis, is not 
a common condition, though seen in mature and aged animals. 
Cases that may be diagnosed with certainty are usually advanced 
affections wherein dependable history is oi)tainable and the symp- 
toms are well marked. 

Rheumatism may ])e thought of, with respect to ai-thritic in- 
flammation caused thereby, as a sort of pyemia. Undoubtedly, 
exposure to wet and cold weather is an active factor, but j)rob- 
ably a predisposing one only. Likewise a member that suffers 
from chronic inflammation due to recurrent injury or to con- 
stant or repeated strain is less able to resist the vicissitudes of 
climate and woi-k. 

Consequently, rheumatic arthritis is to be seen affecting horses 
that are in service, more often at heav.v draft work where they 
are exposed to severe straining of joints; where stabling is in- 
sanitary; and where they are obliged to lie down (if they do 
not remain standing) upon cold and wet ground or upon hard 
unbedded floors or paving. 

Where such inhumane and cruel treatment is given animals 
those responsible ought to be impressed with the unfairness to 
the animal as well as the economic loss ccca.sioned by inflicting 
such unnecessary and merciless treatment upon their helpless 
and imcomplaining subjects. The very nature of the veteri- 
narian's work affords him constant and fi-equent opportunity to 
convince those who are resj^onsible for keei)ing animals in this 
manner, that it is iidiumane and uni)i'ofltal)le. 

Cases of this kind ai-e not unconnnon about some grading and 
lumbering camps and in contract work where, often, shelter for 
animals is given little thought: the i-esult is a cruel waste of 
horseflesh. 

Chi-onic ai'ticulai- rheumatism is occasionally observed in 
young animals that have never been in service. In these cases 
it seems that there exists an individual susceptibility and in 



ETIOLOGY AND OCCURRENCE 27 

some instances the condition is recurrent. Each attack is of 
longer duration, and eventually death results from continued 
suffering, emaciation and intoxication. 

AFFECTIONS OF BURSAE AND THECAE. 

Acute bursitis and theeitis is of frequent occurrence in horses 
because of direct injury from contusion, punctures and other 
forms of traumatism. These synovial membranes, with few ex- 
ceptions, when inflamed occasion a synovitis that may be very 
acute, yet there is less manifestation of pain than in arthritis. 

It is only in structures such as the bursa intertubercularis or 
in the sheath of the deep digital flexor that an inflammation 
causes much pain and is apt to result in permanent lameness. 
This is due to the peculiar character of the function of such 
structures. 

An acute inflammation of a small bursa may even result in the 
destruction of such synovial apparatus without serious incon- 
venience to the subject, either at the time of destruction or there- 
after. Obliteration of the superficial bursa over the summit of 
the OS calcis is not likely to cause serious inconvenience or distress 
to the subject unless it be due to an infected wound. Even then, 
with reasonably good care given the animal, recovery is almost 
certain. Complete return of function of the member and cessa- 
tion of lameness takes place within a few Aveeks in the average 
case. 

Where an infectious synovitis involves a structure such as the 
sheath of the tendon of the deep digital flexor (perforans) the 
condition is grave and because of the location of this theca the 
prognosis is not much more favorable than in an articular syn- 
ovitis. 

Inflammation of bursae and thecae may be cla.ssified on a 
chronological basis with propriety because the duration of such 
affections, in many cases, materially modifies the result. A 
chronic inflammatory involvement of a theca through which an 
important tendon plays may cause adhesions to foi'm. Or there 
may occur erosions of the parts with eventual ]iyi)ertrophy and 
loss of function, partial or complete. 

However, in general practice a classifictition on an etiological 



28 LAMENESS OF THE HORSE 

basis is probably more practical and we shall consider infiamnia- 
tion of biirsae and thecae as infectious and noninfectious. 

Infectious bursitis and thecitis is usually the result of direct 
introduction of septic material into the synovial structure by 
means of injuries. Infection by contiguous extension occurs and 
also metastatic involvement is mot with occasionally. 

The noninfectious intianimation of bursae and thecae usually 
result from contusions or strains and generally run their course 
without becoming infective in character, where vitality and re- 
sistance of the su])ject are normal. 

In a general way, inflammation and other affections of bursae 
and thecae are considered very similar to like affections of joints. 

AFFECTIONS OF MUSCLES AND TENDONS. 

]\ruscles and tendons having to do with locomotion are more 
frequently injured than are any of the other structures whose 
function is to propel the body or sustain weight. This is due 
in part to the exposed position of muscles and tendons. They 
serve as a protection to the underlying structures and in this 
manner receive many blows the force and violence of which are 
spent before injury extends beyond these tissues. 

Muscles of the breast, shoulder and rump are most frequently 
the recipient of injuries of various kinds. The abductors of the 
thigh are subjected to bruising when horses are thrown astride 
of wagon poles or similar objects. Thus in one way or aiiolher 
muscle injuries are occasioned and cause lameness. 

Traumatic affection of muscles of locomotion may be surface 
or subsurface — subsurface with little injury done the skin and 
fascia, but with subsurface extravasation of l)lood and mascera- 
tion of tissue. Puncture wounds wherein the vulnerant body is 
of small diameter, are observed, and they occasion deep seated 
infectious inflammation of the parts affected, with surface 
wounds that are often unnoticeable. Such injuries — puncture 
wounds — are always serious, and because of the fact that there 
exists little evidence of injury at the time of their infliction, 
treatment is usually deferred several days and often infection 
has become quite extensive when the practitioner is consulted. 

Where infective wounds of nuiscles of locomotion occur, the 



ETIOLOGY AND OCCURRENCE 29 

course and gravity of the affection are directly influenced by the 
proximity of the injury to lymph plexuses. For instance, in- 
juries causing an infectious inflammatory involvement of the ad- 
ductors of the thigh may result in a generalization of the infec- 
tion by way of the inguinal lymph glands. 

Large open wounds that extend deep into muscles, render 
inactive such structures, and even where division is not com- 
plete, the pain occasioned causes the subject to favor the part 
in every way possible. Contraction of muscular fibers of such 
parts increases pain and because of this fact groups of muscles 
are at times disabled because of injury done to one muscle. In- 
stances of this kind are frequently seen where shoulder injuries, 
which affect but one muscle, exist; yet because of such injury a 
marked swinging-leg lameness is present. 

Tendons, because of their inelasticity, are subjected to injuries 
peculiar to themselves. In addition to being affected as are mus- 
cles, wounds of many kinds are found to affect tendons — con- 
tusions, interference wounds, penetrant wounds, incised wounds 
and lacerations. 

However, the commoner form of injury done tendons, is strain 
or sprain. Because of the sudden tensile .strain brought to bear 
upon tendons in the shocks of concussion, as well as in propulsion 
of the body, there frequently occurs a rupture of fibers and this 
we know as sprain. 

Sprains may be considered as fibrillary fractures of soft struc- 
tures and since this form of injury is subsurface, and limited to 
fractional portions of tendons, the inflammation occasioned. usu- 
ally remains an aseptic one. Reaction to this form of injury 
is characterized by inflammation, the course of which is erratic 
and variable. In chronic inflammation of tendons, where ani- 
mals are continued in service, the usual sequel is contraction, or 
shortening of these structures. 

The degree of contraction as well as its import varies in dif- 
ferent subjects and in the vai'ious tendons which may be affected. 
Contraction is a slow-going process that is progressive, gradually 
causing a decrease in the length of the affected structure and 
eventually rendering the animal useless. 

The practice of applying shoes with extended toe-calks for 



30 LAMENESS OF THE HORSE 

the purpose of "stretching" contracted deep digital llcxor 
tendons (Hexor pedis perforans) cannot be too strongly con- 
dennied. While the addition of an extension such as is ordinarily 
employed to the toe of a shoe of this kind, prevents for a time, 
freciuent stuml)ling in such cases, the increased tensile strain 
which is thus occasioned hastens further contraction and sub- 
jects animals so shod to much unnecessary pain. 

AFFECTIONS OF NERVES. 

Because of their being protected by other structures, nerve 
trunks, which supply muscles of locomotion, are not subjected to 
frequent injuries such as contusions. However, they do become 
injured at times and the result is lameness, more or less severe. 

Lameness originating from nerve affection, may involve central 
structures as, for example, the spinal cord, medulla oblongata 
or parts of the brain. In making an examination of some lame 
animals it is necessary to distinguish between cases of lameness 
that are of central origin and marked by incoordination of move- 
ment, and disturbances caused by other affections. Tetanus in 
its incipiency should not be confused with laminitis involving 
all four feet, or with certain forms of pleuritis, when careful ex- 
amination is made, yet, in a way, to one not trained, the clinical 
symptoms are similar. 

Disturbances of nerve function are caused in a variety of ways. 
It is not within the scope of this work to discuss central nervous 
disturbances caused by ingestion of mouldy provender, or dis- 
turbances of the brain or cord occasioned by infectious diseases, 
but mention of the existence of such conditions is appropriate. 

By direct injury the result of blows, certain nerves are in- 
jured and muscles supplied by such nerves are rendered inactive. 
Depending upon the nature and extent of an injury thus in- 
Hieted, so the manner in which the affection is manifested varies. 
The suprascai)ul;n- nerve is rather fre(|uently injui-rd causing 
partial or complete loss of function of the structures supplied 
by this nerve, and alxluction of the scapulohumeral joint nat- 
urally results. 

In some cases of dystocia the ol)turator nerve, (or nerves, if 
the involvement is bilateral), becomes injured by being caught 



ETIOLOGY AND OCCURRENCE 31 

between the maternal pelvis and some dense part of the fetus. 
This results in paralysis of the adduetor-s of the thigh if suffi- 
cient injury is done. 

It is said that nerves l)eeome over-stretehed and held tense, in 
certain positions in which animals are obliged to remain while 
cast in confinement such as in some instances where unusual 
methods of restraint are employed. When the fore feet are 
drawn backward in such manner that great strain is put upon 
the radial nerve, it suffers more or less injury, and this is fol- 
lowed by partial or complete paralysis which may be temporary 
or permanent. 

Degenerative changes affecting nerves, as in other tissues, oc- 
cur and more or less locomotory impediment will follow — this 
depending upon the nerve or nerves affected and the nature of 
such involvement. Tumors may surround nerves and eventually 
the nerve so exposed becomes implicated in the destructive 
process. Before degenerative changes take place in the nerve 
substance, in such cases, pressure may completely paralyze a 
nerve when it is so situated. Melanotic tumors in the para- 
proctal tissue in some cases, because of the large size of the new- 
growths, cause paralysis of the sciatic nerve. The author has seen 
one case of brachial paralysis occasioned by an enormous de- 
velopment of fibrous tissue involving the structures about the 
ulna. 

AFFECTIONS OF BLOOD VESSELS. 

Lameness caused by disturbances of circulation may be due to 
structural affection of vessels, or functional disorders of the 
heart, and in some instances, a combination of these causes may 
be active. 

Direct involvement of vessels is the commoner form of circu- 
latory disturbance which occasions lameness, and the most fre- 
quent cause is of parasitic origin. Sclerostomiasis with attendant 
arteritis, thrombus formation and subsequent lodgement of em- 
boli in the iliac, femoral, or other arteries, causes sufficient ob- 
struction to prevent free circulation of blood, and the character- 
istic lameness of thrombosis results. 

Indirect injury to vessels may occur because of contused 
wounds and subsequent inflammation of tissues supplied by such 



32 LAMENESS OF THE HORSE 

vessels. If the injury be of sufficient extent, considerable ex- 
travasation of blood will take place and the painfully swollen 
parts necessarily impair locomotion. In such instances lymph 
vessels participate in the disturbance, and the condition then be- 
comes one wherein lymphangitis is the predominant disturbing 
element. 

Angiomatous tumors are occasionally found affecting horses' 
legs — usually the result of some injury; and because of their size 
or position, they mechanically interfere with function. Further- 
more, when such tumors are located on the inner or flexor side 
of joints, enough pain is occasioned that affected animals show 
evidence of distress, usually by intonnittent lameness. 

Horses do not suffer from distension of veins as does man, 
that is, there is rarely to be seen a case wherein much disturbance 
from this source exists. 

AFFECTIONS OF LYMPH VESSELS AND GLANDS. 

Inflamed lympli vessels and glands, the result of various causes, 
is a rather common source of lameness of horses. "When one con- 
siders the proportion of tissue that is composed of lymph vessels 
and glands, it is then obvious that inflammation of these struc- 
tures should cause a painful affection of members, when so af 
fected, and that marked lameness and, in some instances, general 
constitutional disturbance such as anorexia, hyperthermia and 
general circulatory disorder are to follow. 

Lymphangitis is most frequently occasioned by the introduc- 
tion of septic material into the tissues ; consequently, infectious 
lymphangitis is more frequently observed than the non-infectious 
type. 

Specific infectious forms of lymphangitis are seen in glanders 
and in strangles; infectious types of this disturbance are found 
in many instances where, initially, a localized or circumscribed 
infection has occurred — the contagium having been introductnl 
by way of an injury. An example of this kind is to be seen in a 
wound perforating the tibial fascia, where the injury is inflicted 
by means of a horse being kicked by another animal shod with 
sharp slioo-ealks. Cases of this kind invariably result in a septic 
lymphangitis, and frequently lymphadenitis also occurs, for the 



ETIOLOGY AND OCCURRENCE 33 

inguinal lymph glands are so situated that their becoming con- 
taminated is almost certain. 

The trite phrase that "the tissues are bathed in lymph" should 
make clear the reason for the frequent occurrence of infectious 
lymphangitis and lymphadenitis. Foreign substances, bacteria 
and their products, inorganic material and in fact, anything that 
is introduced into the tissues, if soluble or miscible, will be taken 
up and conveyed by the afferent lymph vessels and disseminated 
throughout the system — hence the constitutional disturbances so 
frequently thus caused. 

A non-infectious type of Ijanphangitis is frequently seen in 
the heavy draft breeds of horses and in such cases one or both 
hind legs are involved — it is very seldom that the thoracic limbs 
become so affected. Law^ refers to this ailment as "Acute 
Lymphangitis of Plethora in Horse." When one takes into 
consideration that these cases so frequently occur in heavj^ draft 
animals that are not worked regularly, that the pelvic limbs are 
the ones involved, and that the disorder often runs a short 
course (recovery often taking place within two or three days, 
with no treatment given other than a purge, circulatory stim- 
ulants and walking exercise) it is plausilile to ascribe the con- 
dition to idiopathic factors. 

Admitting the frequency of non-infectious lymphangitis, the 
practitioner must not confuse this type with similar lymphatic 
inflammation occasioned by nail punctures of the foot. It is 
very embarrassing indeed to make a diagnosis of lymphangitis — 
expecting that the disturbance will terminate favorably and un- 
eventually — and later to discover a sub-solar abscess caused Dy 
a nail prick in the region of the heel. 

Recurrent attacks of this disturbance cause h.ypertrophy of 
the lymph vessels and in some cases lymphangiectasis. In old 
subjects used for dissection or surgical purposes, it is very evi- 
dent that in the ones which have suffered from chronic lymphan- 
gitis there exists an excessive amount of sub-facial connective 
tissue, making subcutaneous neurectomies quite difficult in some 
instances. 

A sequel of chronic lymphangitis is a condition known as ele- 



'Vol. I, page 534, Veterinary Medicine, by .Tames Law, F. R. C. V. S. 



34 LAMENESS OF THE HORSE 

plianlijisis. In such cases there occurs a liyi)erplasia of the skin 
and subcutaneous tissues, resulting in some instances, in tlie af- 
fected nieinlier attaining an enorinous size. Sporadic cases of 
tliis kind are to l)e seen occasionally, and are apparently caused 
hy repeated attacks of lymphangitis. Tln' alTcction is not l)(Mie- 
fited by treatment, and while a horse's les.( may l)ecomc so heavy 
and cumbersome as to mechanically impede its gait, as well as 
to fatigue the subject when made to do service even at a slow 
pace, elephantiasis causes no constitutional derangement. The 
hind legs, in elephantiasis, are affected and a unilateral involve- 
ment is more often seen than a bilateral one. The legs may be 
enlarged from the extremity to the body, but ordinarily the af- 
fection does not extend higher than the hock or the mid-tibial 
region. 

A chronic, progressive, l!yper])lnstic-degeneration exists in 
some cases and the subjects are in time rendered unserviceable 
because of the burden of getting about encumbered by the affected 
extremity. In other animals hyperplasia progresses for a time 
— until the parts become greatly enlarged and conditions appar- 
ently attain an immutable state. Nevertheless animals so af- 
fected may continue in service for years without being distressed. 

AFFECTIONS OF THE FEET. 

Lameness is very often due to affections of the feet, and in all 
foot diseases probably the most constant cause is injuiy intlieted 
in some manner. Resultant from injury, there fre(|uently de- 
velops complications and the one most often seen is infection. 

Because of the fact that the feet are constantly expo.sed to 
germ-laden soil and filth, if not actually bathed in such infectious 
materials, it naturally follows that septic infection of some part 
of the feet must be of frequent occurrence. 

Subsequent to being obliged to .stand in mud and other damp 
or wet media, exposure to desiccating influences such as stabling 
ujion dry floors, or at service on hot and di-y road surfaces causes 
the insensitive parts of the feet to become diy. liard and brittle. 
This favors ''checking" of the proteetinir structures and it fre- 
(picntly results in the fornu\tioii of large fissures which expose 



ETIOLOGY AND OCCURRENCE 35 

the underlying sensitive parts of the feet and lameness is the in- 
evitable outcome. 

The function of the feet — bearing the vreight of the animal at 
all times when the subject is not recumbent, and in addition to 
this, the increased strain put upon them at heavy draft work, 
together with the concussion and buffeting occasioned by locomo- 
tion, make the feet susceptible to frequent affections of various 
kinds. 

Being almost completely encased by a somewhat inexpansiblo 
and insensitive Avail and sole, renders the foot subject to path- 
ologic changes peculiar to itself. The very nature of the struc- 
ture of the foot together with the function of the sensitive lamina 
is sufficient cause for an affection unlike that seen involving other 
tissues — laminitis. 

An exhaustive consideration of foot affections is a study in 
itself and one that comes within the realm of pathologic shoeing ; 
nevertheless, a practical knowledge of diseases of the foot is 
indispensable in the diagnosis of lameness wherein the foot may 
be at fault. 

The peculiar nature of foot affections renders them difficult 
of classification on any sort of basis that is helpful in the con- 
sideration of this subject. Injuries are the most constant cause 
of foot lameness, yet one must admit that there results compli- 
cations because of infection in most instances ; and that in some 
cases the injury is slight — just enough to permit the introduction 
of vulnerant organisms into the tissues. Therefore, one might 
well classify affections of the feet as infectious and non- 
infectious. There can be grouped in the class of infectious af- 
fections such conditions as nail pricks, calk wounds and canker. 
In the class of non-infectious affections one may consider condi- 
tions such as laminitis, strain and fractures. 



SECTION II. 
DIAGNOSTIC PRINCIPLES. 

To observe attentively is to remember distinctly. — Poe. 

Before treatment is administered in constitutional disturb- 
ances resulting in disease, cause is logically sought; so, in 
order to handle effectively any case of lameness, it is necessary 
tirst to discover the source of the troul:)le and contributing con- 
ditions affecting the structures. Hence, diagnostic ability is 
the prime requisite; and a thorough knowledge of pathologic 
anatomy or of surgical teclmic is of little value if this knowledge 
is not applied with the insight of the trained diagnostician. 

The cruel and unnecessary methods employed by those un- 
trained for diagnostics, cannot be too vigorously condemned. For 
instance, the application of an active and depilating vesicant 
upon a large area on the gluteal or crural region, in a case 
where the practitioner "guesses" the condition to be one of 
"hip lameness," constitutes an exposition of gross ignorance, 
and at once stamps the perpetrator as a crude bungler without 
scientific insight whose works are no credit to his profession. 
How much better it would be, if the practitioner does not see 
fit to call in a competent consultant, to prescribe a suitable agent 
to be given internally, and to recommend complete rest for the 
subject. 

In establishing a diagnosis in such cases, the student or prac- 
titioner seldom has recourse to laboratory assistance, and his 
work is done by means of physical examination ; therefore, a 
thorough knowledge and a clear conception of the physiology 
of locomotion are essential. Memorizing nosological facts with- 
out an understanding of underlying principles is of no more 
practical benefit for qualification as a diagnostician in cases of 
lameness, than is the employment of similar methods in the 
study of theory and practice. A knowledge of the dosage of 
drugs does not in itself qualify one as being competent to ad- 
minister such therapeutic agents to a proper effect. How 

37 



38 LAMENESS OF THE HORSE 

iiuic-li is u prai-titioiicr benefited t»y the knowledge that a liif.'li 
temperature is usually pr&sent in septic intoxication, if he is 
not possessed of a scientific understanding of anatomy, physi- 
ology, l)acteriology and pathology, as well as the ijrincijjles of 
clinical diagnosis? 

In order to determine the reasons for certain symptoms mani- 
fested by the subject, an analysis of these symptoms is the jiroper 
method of procedure, insofar as this is pos,sible. If one may 
reason that an animal assumes a certain position while at rest 
to allow relaxation of an inflamed tendon or ligament, such a 
fact enables the diagnostician to recall that this is indicative 
of some specific ailment. In acute tendinitis, the subject while 
at rest, maintains the affected member in volar flexion because 
this position permits relaxation of the inhibitory apparatus, 
including the inflamed tendon. Likewise, the various abnormal 
positions assumed. — adduction, abduction, undue flexion or 
pointing — have their own significance and are taken into ac- 
count by the trained diagnostician in the course of an examina- 
tion. 

In the examination of lame subjects, where the cause is not, 
obvious, a systematic method of diagnosis is pursued even by 
the most expert practitioners. In all obscure cases of lameness 
a methodical and thoroughly practical examination of the ani- 
mal according to an established procedure is necessary to de- 
termine the nature and source of the afTliction. 

Anamnesis. 

The first thing to be given consideration in diagnosis is the 
fact that related history of the case is not always dependable, 
because of lack of accurate ohservation or wilful deceit on the 
part of the owner or attendant. The successful veterinarian 
soon acquires the faculty of obtaining information in a manner 
best adapted to his client, — either by direct interrogation or by 
subtle means of suggestion, and in this Avay he draws out evaded 
facts essential to his diagnosis. In time he learns to make al- 
lowance for misstatements made to shield the owner or driver 
and to hide the facts of apparent neglect or ahuse that the sub- 
ject nuiy have experienced. A suppurating cartilaginous quittor, 



DIAGNOSTIC PRINCIPLES 39 

complicated by the presence of a large amount of hyperplastic 
tissue, cannot be successfully represented to ])e an acute and 
recently developed affection, where a trained practitioner is left 
to judge the validity of the statement. 

In complicated conditions, where there is evident a chronic 
disturbance which could not be conceived as sufficient cause for 
a marked manifestation of lameness, accurate history of the case 
may be of great aid in arriving at a diagnosis. An aged animal, 
having recently become very lame, showing a small exostosis on 
the first phalanx, and with the history given that the osseous 
deposit was of long standing, should at once lead the veterinarian 
to seek the source of trouble elsewhere. 

Visual Examination. 

As in all diagnostic work, a careful visual examination of the 
subject should lie made before it is approached. The novice is 
given to hasty examination by palpation, not realizing how 
much may be revealed ])y a careful scrutiny of the subject. In 
this way he is led to erroneous conclusions which the skilled 
diagnostician has learned from experience to avoid. Too much 
emphasis cannot he placed on the importance of making a 
thoughtful visual examination in every instance before the sub- 
ject is approached. In this examination, type, conformation 
and temperament are taken into account at once, for each of 
these qualities is in itself, a determining factor in predisposing 
a subject to certain ailments or inherent attributes, which may 
exert a favorable or unfavorable influence upon existing condi- 
tions and thus make recovery probable or otherwise. 

Draft animals are less likely to be permanently incapacitated 
as a result of tendinitis, than are thoroughbreds. Likewise, 
one would not expect to find this affection present in heavy 
harness horses as frequently as in light harness animals. 

]\Ial-formation of a part, or an a.symmetrical development of 
the body as a whole, may render an animal susceptible to cer- 
tain affections which cause lameness. A "tied in" hock predis- 
poses the su])ject to curb, and an animal having powerful and 
well-developed hips and imperfectly formed hocks, will, if sub- 
jected to heavy work, be a favorable subject for bone spavin. 



40 LAMENESS OF THE HORSE 

Tlie matter of temperament cannot be disregarded in diag- 
nosis, lor in some instances, it is the chief determining factor 
which materially influences the outcome of the case. A nervous, 
excitable animal, that is kept at hard work, may, under some 
conditions, be expected to exi)erience disturbances which more 
lethargic subjects escape. Nervous subjects, it is known, are 
more prone to azoturia than are those of lymphatic temperament. 
Furthermore, the lymphatic subject often recovers from cer- 
tain l)one fractures which are successfully treated only when 
the animal is sufficiently resigned by nature to remain confined 
in a sling for weeks without re«istauce. 

The physiognomy of a subject is often indicative of the gravity 
of its condition. The facial expression of an animal suffering 
the throes of tetanus, azoturia, or acute synovitis, is readily 
recognized by the experienced eye, and upon physiognomy alone, 
in many instances, may the opinions regarding prognosis be 
based. Particularly is this true where death is a matter of min- 
utes, or at most is only a few hours distant. 

Due allowance siiould be made for restiveness manifested by 
some more nervous animals when the surroundings are strange 
and unusual. In such instances, even pathognomic symptoms 
may be masked to the extent that little, if any, sign of pain 
or malaise is evinced. In these cases the subject should be 
given sufficient time to adjust itself to the new environment, or 
it should be removed to a more suitable place for examination. 
Animals quickly detect the note of friendly reassurance in the 
human voice and can very often be calmed by being spoken to. 

\iy visual examination one may detect the presence of various 
swellings or enlargements, such as characterize bruises and 
strains of tendons where inflammation is acute. Inflammation 
of the plantar (calcaneocuboid) ligament in curl) is readily de- 
tected when the affected member is viewed in profile. Spavin, 
ringbone, splints, quittor and many other anomalous conditions 
may all be observed from certain proper angles. 

The fact that the skins of most animals are pigmented and 
covered with hair, precludes the easy detection of erythema by 
visual examination, consequently this indicator of possible in- 



DIAGNOSTIC PRINCIPLES 41 

flammation is not often made use of in the examination of 
equine subjects. 

Attitude of the Subject. 

The position assumed while the subject is in repose, is often 
characteristic of certain affections and tins, of course, is noted 
at once. The manner in which the weight is borne by the animal 
at rest, should attract the attention of the diagnostician and if 
the attitude of the subject is abnormal or peculiar, the ex- 
aminer tries to determine the reason for it. If weight-bearing 
causes symptoms of pain, the affected member will invarialily be 
favored and held in some one of a number of positions. The 
foot may contact the ground squarely and yet the leg may re- 
main relaxed and free from pressure; volar flexion, in such 
cases, is indicative of inflammation of a part of the flexor ap- 
paratus. If the condition be very painful, position of the af- 
flicted member is frequently shifted, but in all cases where the 
pain is not so keenly felt, the inflamed member is held in a 
state of relaxation. There is need then, for a laiowledge of 
anatomy and certain principles in physics to enable the observer 
to determine just wdiich structures are purposely eased in this 
manner. Where palpation of parts is possible, one does not 
need to depend on visual examination alone, and it is always 
wise to take into consideration every factor that may influence 
conditions. Manipulation or palpation of the stnictures thought 
to be involved, should not be resorted to until a careful and 
thorough observation of the subject has revealed all that it can 
reveal to the diagnostician. 

In all conditions where extreme pain is manifested by the 
constant desire of the animal to keep its foot in motion off 
the ground, examination should be made for local cause. This 
is seen in certain septic inflammations of the feet such as those 
caused by nail punctures invading the navicular joint, or in 
newly made wounds where nerves have been divided and the 
proximal end of such a nerve is exposed to pressure or irritation. 

"Pointing" affords a comfortable position in some cases of 
navicular disease, and in a unilateral affection, one may observe 
the subject bearing weight with one sound member, while the 
affected foot is planted well ahead of the sound one. In a bi- 



42 LAMENESS OF THE HORSE 

l;it('i-;il invoht'iiiciit of tliis kind, wcii^lit iiuiy he l'n'(|uciitly 
shifted from one foot to the other, or in chronic cases, where 
no marked pain is experienced, the subject stands squarely upon 
both front feet and no peculiar shifting of weight or pointing is 
evident. 

In some cases of hip or shoulder involvement, complete re- 
laxation of all parts of the affected member may be noticed. 
In brachial paralysis, the pectoral member is held limply; if the 
patient is made to move, it is evident there is lack of innerva- 
tion to the afflicted part. In some ca.ses where contusion has 
caused acute inflanunation of the member, the subject instinct- 
ively tries to keep it inactive to relieve the pain which move- 
ment occasions. 

AVhere there is an active and i)ainful inflammation of the 
prescapular lymph glands and contiguous structures, in some 
cases of "levator-humeri abscess," the scapulohumeral joint is 
extended. This is brought about by flexion of the elbow and 
carpal joints. 

There are some cases of bi-lateral affections which occasion 
such pain during weight-bearing that the subject shifts its 
weight from one affected leg to the other; an example of this 
condition may be observed in any acute ease of gonitis which 
affects both patellar regions, making it equally painful to ])ear 
the weight on either member. 

A peculiar characteristic position is assumed in acute laminitis 
of the fore feet. In such instances, the hind feet are brought 
forward under the body sufficiently to relieve the front feet of 
the weight, insofar as is possible by the abnormal position taken 
in cases of acute laminitis. 

So in each position that is abnormal 1o any degree, assumed 
by a suffering animal, there may be deduced, the fact that the 
subject is attempting to relieve the affected structures, and in 
each clinical picture of this kind, the trained diagnostician sees 
some index to the nature and source of the trouble. Further 
examination is rendered more effective because of this prelim- 
inary visual examination which has precluded the unnecessary 
annoyance of the animal by manipulating unaffected structures. 

It has i)een presupposed in the foregoing, that the one mak- 



DIAGNOSTIC PRINCIPLES 43 

ing visual examination of a lame animal for diagnostic i)urpos6S, 
will remember that with the normal animal the weight is borne 
equally well with both fore legs; and that this is done without 
shifting from one to the other; and that the pelvic limbs do not 
support the body in this manner. Normal subjects shift their 
weight from one hind leg to the other and the one relaxed, rests 
in a state of flexion with the toe on the ground and the heel 
raised. 

Exaonination by Palpation. 

In nearly every case where lameness exists an examination of 
the affected parts, by palpation or by digital manipulation, 
is necessary before an accurate conclusion may be drawTi; but 
in making this kind of an examination one needs to exercise good 
judgment lest he fail to acquire a correct impression of the 
actual existent conditions. There is need for the diagnostician, 
here, as well as in other conditions where physical examination 
is made, to approach the subject in a manner that will not ex- 
cite or disturb to the extent that the animal will, in one way 
or another, resist or object to the approach of the diagnostician, 
thereby masking the symptoms sought. The practitioner would 
best acquire skill as a horseman — if he is not possessed of such 
— and handle each individual subject in the manner calculated 
to best suit the temperament of the animal examined. The 
unbroken subject is not handled as satisfactorily as is the in- 
telligent family horse ; in the former, in some cases, little de- 
pendence is placed upon digital examination. 

By palpation one is enabled to recognize hyperthermia and 
this, in lieu of dependable histor}^, is at times sufficient evidence 
upon which to determine the duration of any given inflammatory 
affection. 

By comparison of different parts of the same memlier or with 
an analogous portion of another member any marked increase in 
the apparently normal temperature of a part at once signalizes 
inflammation. In this manner, in examining a case where 
laminitis or other inflammation of the feet is suspected, one may 
arrive at a fairly accurate conclusion without the employment 
of other means. Throbbing vessels are not always easily rec- 
ognized if the subject is a victim of chronic lymphangitis. 



44 LAMENESS OF THE HORSE 

In some instances, where a moderate degree of lameness exists 
and cause is ai)pareiitly obscure, the recofjnition of liyperthermia 
may be the deciding factor in establishin<( a diagnosis. In cases 
of sprained ligaments in the phalangeal region, because of the 
dense character of the structures involved, little if any evidence 
of the cause of lameness, other than local heat, nuiy be found 
twenty-four hours after the injury ha.s Ijcen inflicted. 

In order to determine the amount or extent of hyperthermia 
with a fair degree of accuracy in any given case, one must make 
due allowance for external conditions affecting temperature : 
also the effect of a considerable amount of hair covering an area, 
as well as any p()ssil)le dirt contacting the surface of the skin 
must be taken into account. All dii-t sliould be removed if prac- 
ticable, so that the diagnostician's iialms may come as nearly 
in contact with the inflamed structures as ]>ossible. Then, too, 
the sense of touch if the operator's liands are chilled, is not de- 
pendable. In sucli instances the novice will need to ])e de- 
liberate as to his findings — whether or not hyperthermia really 
exists. Such an examination is of little value where the sub- 
ject's feet are wet and an examinati(m is hurriedly made, as in 
cases of suspected laminitis. 

Often, before being able to distinguish the presence of a 
hyperthermic condition, one is impressed with the fact that an 
animal manifests evidence of beins: supersensitive. In fact, 
some animals in the anticipation of pain at the touch of an in- 
jured part, will instinctively withdraw — in self-protection — such 
an ailing member or resist the approach of the practitioner. This 
sensitiveness is more apparent in animals that have been sub- 
jected to previous manipulation or treatment which has oc- 
casioned pain, and consequently, allowance must be made for 
this exhibition of fear. No better example of this condition can 
be imagined than is present in cases of "shoe boil," where 
there exists an extensive area of acute inflammation of the el- 
bow. There is always more or less surface disturbance wherever 
vesication has been produced, and in cases where irritants of 
any kind have been employed for several days or a week previous 
to an examination, more or less supersensitivene.ss is to he ex- 
pected. 



DIAGNOSTIC PRINCIPLES 45 

One must not lose sight of the fact that unscrupulous dealers, 
— "traders" — make use of their knowledge of this principle in 
various way usually for the purpose of attracting attention to 
a part, which, presumably might have been blistered in order to 
intentionally produce inflammation of tissu^^s, in this way, 
causing lameness which is not manifested until an animal has 
been kept by its new owner for twenty-four hours or more. 
This, to be sure, usually makes a dissatisfied purchaser who is 
willing to dispose of his newly acquired animal at a sacrifice, 
thus enabling the original owner or his agent to regain posses- 
sion of the victimized animal at less than its real value. 

Some nervous animals, because of the manner of approach of 
the practitioner, are wont to flinch, and there is manifested a 
pseudo-supersensitiveness. Young animals not accustomed to be- 
ing handled are likely to be timorous, and one must not hastily 
conclude tliat a part is painful to the touch liecause the subject 
resents even gentle digital manipulation of such parts. In 
instances of this kind, one needs to compare sensibility by manip- 
ulation of different parts of the subject's body in a careful and 
gentle manner ; and by exercising patience and good judgment 
in such work, it is possible to actually distinguish between nor- 
mal sensibility and abnormal sensitiveness, in most cases. Here, 
again, the diagnostician needs to possess skill as a horseman and 
good judgment as to individual temperament of different animals, 
under any condition which may exist at the time he makes his 
examination. 

By palpation alone, one can recognize the presence of fluctu- 
ating enlargements; one may not only recognize such conditions, 
hut distinguish between a fluctuating ma<s such as exists in non- 
strangulated hernia and a large fibrous tumor. By palpation, 
for the recognition of density and for determining the presence 
or absence of hyperthermia, one may decide that there exists 
an abscess and not a tumor. Edematous swellings are recog- 
nized by palpation. — the characteristic indentations which may 
l)e made in dropsical swellings are pathognomonic indicators. 
In this manner it is easy to differentiate jjost-ojiei-ative or post- 
traumatic edemas which may or may not cause lameness. At 
any rate, it is essential to take iiito ficcount all determinate con- 



46 LAMENESS OF THE HORSE 

ditions that iiuiy assist in the jji-o^nosis of" any j^ivcn case, 
for the purpose of being able to outline i-atioiial rniirdial 
measures. To be able to distin<;uish between the ^'eiieralization 
of a septie infection in its ineipieney, and a more or less benign 
edema, is largely possible by digital manipulation alone. An 
extremity may be greatly swollen because of the existence of 
chronic lymphangitis, intluenza, or an acute septic infection oc- 
casioned by the introduction of pathogenic and ai-rogenic or- 
ganisms. Since the effect produced by these dissimilar ailments 
are productive of conditions that may terminate favoral)ly or 
unfavorably, it becomes necessary for the diagnostician to de- 
velop a trained, discriminating, tactile-digital sense, in order to 
correctly interpret existing conditions, and handle cases in 
a rational and skillful manner. 

In order to ascertain the extent and exact location of a tumor, 
an exostosis, or other enlargements, the diagnostician, here also, 
needs to be in possession of a trained tactile sense and in addi- 
tion if he be fortified with an accurate knowledge of normal anat- 
omy and pathology, he is able to arrive at proper conclusions, 
when digital manipulations have been employed. Fibrous tu- 
mors are sometimes located in the inferior part of the medial 
side of the tarsu.s — exactly over the seat of bone-spavin. Such 
tumors, when the affected member is supporting weight, are not 
to be distinguished from exostoses; but as soon as the affected 
leg cea.ses to ])ear weight, it may be passively flexed and the 
nature of the enlargement recognized because it may lie slightly 
displaced by digital manipulation. Displacement, of course, is 
not possible with an exostosis. 

A necessary qualification, which the diagnostician nuist pos- 
sess, is that of being able to judge carefully the nearness of any 
given exostosis to articular structures. Also, the extent or area 
of the base of an exostosis as well as its exact position, needs 
be determined before one may estimate the probable outcome 
in any case, — whether treatment should be encouraged or dis- 
couraged by the practitioner. Periarticular ringbone may, be- 
cause of the size and location of the exostosis, constitute a con- 
dition which cannot be relieved in any way in one case, and in 
another, because of the manner of distribution of such osseous 



DIAGNOSTIC PRINCIPLES 47 

deposits, the condition may be such that prompt recovery will 
follow proper treatment. In the examination of an exostosis of 
the tarsus, it is particularly important to determine the exact 
location of the exostosis — whether or not the spavin involves 
the tibial tarsal (astraj];ulus) bone very near its til)ial articular 
portions. Obviously, if articular surfaces of joints are involved, 
complete recovery caiuiot result despite the most skillful atten- 
tion given the subject. 

Passive Movements. 

Wherever it is possil)Ic to gain the confidence of a tractal)le 
animal to the extent that it will relax the structures suiSciently 
to make possible i)assive movement of affected parts, much is 
to be learned as a result of such manipulation. By this method 
one may differentiate true crepitation, false crepitation, luxation 
and inflammation of ligaments that have been injured, as in 
sprains of such structures in the phalangeal region. 

Tr}!e crepitation is recognizable by the characteristic vibra- 
tion which is interpreted by tactile sense. It is possible to rec- 
ognize fracture by the use of other methods — auscultation, tun- 
ing fork tests, etc., but in ordinary veterinary practice one must 
rely upon the sense of touch for recognition of crepitation. 

Where pain is not so great that relaxation of parts does not 
occur, one can, b.y gently moving an extremity in various di- 
rections — as in flexion, extension and lateral motion as well as by 
rotation — cause to be manifested this peculiar grating, — the 
friction of newly broken bone. This is known as tr\ic crepitation. 
Where the subject, suffering phalangeal fi-acture, manifests 
evidence of pain due to tensing the structures about a fractured 
part, one may anesthetize the parts by using al)out two cubic 
centimeters of a two ]ier cent, solution of cocain upon the plantar 
nerves, proximal to the fracture. It is perhaps best to deposit 
the cocain solution by means of two hypodermic punctures at 
different points along the course of each nerve, though closely 
situated to one another, thereby making more sure of the so- 
lution actually contacting the nerve. \\\ some nndtiple frac- 
tures of the first or second phalanx this is quite necessary; 
otherwise, pain produced by passive manipulation causes the 



48 LAMENESS OF THE HORSE 

sul)jeet to keep the tfiidons so t(>nsc tliiil crt'pitatioii may not 
be deteett'd. The uii necessary iiiHietion ol" i)aiii is always to be 
avoided. 

We know as falsf cnpilation a vit)i-ating inii)ulse occasioned 
l\v normal contact of articular portions of bones such as in the 
nietacarpophalan^'eal joint when this structure is passively 
moved, where the subject permits the parts to remain in a state 
of complete relaxation. 

Attempts to reco^ize supersensitiveness or inflammation by 
means of passive movement of the shoulder or hip, whether 
gently or forcefully, is not i)roductive of good, in any case, in 
large aninials. Because of the bulk and weight of parts so 
manipulated, as well as the resistance the subject offers even 
in normal cases, no accurate conclusion is to be arrived at in 
this manner in the average instance. Aninuils nearly always 
resist the placing of members in any position that is so unusual 
and uncomfortable as that which is required to materially dis- 
place the component ti.«.sues of the shoulder or hip: therefore, 
such i)ractice is useless l)ecause one can not distinguish lictwiM'n 
normal resistance and flinching caused by painful sensations in 
injurcnl ]iai-ts. Sueli manipulations are iiractical in small ani- 
mals. 

Observing the Character of the Gait. 

In order to determine the degree of lameness as well as its 
character, it is necessary to cause the subject which is being 
examined, to move in some manner. The degree of inconvenience 
or distress experienced by a lame animal that is being so ex- 
amined is manifested by the character of the claudication; and 
where much pain is occa.sioned in locomotion there is disturbance 
of respiration ; perspiration may be noticeable and in some in- 
stances manifestation of nervous shock are very evident — this in 
timid, nervous animals that anticipate being punished when 
approached and, consequently, make (^very effort jjossible to 
move when urged to do so. An animal, iben. should be moved 
only sufficiently to cause it to exhibit Itie degree of lameness 
present in any given case, and if a marked impediment is mani- 
fested it is not necessary to cause the subject to be exerted to 



DIAGNOSTIC PRINCIPLES 49 

the extent of iutiieting, in sueli manner, unnecessary punishment. 
Further or eonclusive examination is made by palpation. To 
cause the snbject to move, an assistant may simply lead the ani- 
mal witli a halter and compel it to walk a few steps. In this 
way, lameness, whether manifested during the weight-bearing 
period of an affected meml)er, or when such a meml)er is being 
advanced, or whether a combination of the two conditions exists, 
is made apparent. In the words of Dollar, one is thus enabled 
to recognize the existence of "supporting-leg-lameness,'' "swing- 
ing-leg-lameness" or "mixed lameness." 

AVhen the cause of lameness is not strikingly apparent it be- 
comes necessary to have the subject moved farther than a few 
steps and at different paces. Depending then, npon the charac- 
ter of lameness manifested, as well as npon its degree of in- 
tensity, one needs to exercise the sul)ject in varions wa^'s, bnt 
this should not be overdone. 

The first thing apparent in the lame subject in action, is the 
lame leg. If this is not readily determinable, as in some compli- 
cated cases, the leg or legs which are at fault are to be dis- 
covered by further examination, and to do this, — word-pictures 
convey little that is helpful in difficult cases, — long practice is 
the one route by which one may become efficient; that is, by ex- 
perience gained after fundamental principles in the diagnosis 
of lameness have been mastered. 

For a careful study of supporting-leg-lameness involving a 
fore limb, the subject is driven or led toward the one making 
such examination. If a hind leg is to be observed, the animal 
is made to travel awaij from the examiner. Where there exists 
swinging-leg-lameness, the subject should be caused to movt 
past the diagnostician, so that he may get a side view of the 
subject while it is in motion. 

In every case such examinations are made to the best ad- 
vantage if the practitioner can view his patient from a little 
distance. Here, again, a visual examination is made but this 
cannot l)e successfully executed, in difficult cases, if the prac- 
titioner is stationed at too close range. 

The average subject is ])est observed by being led, rather than 
being ridden, and in so doing tlie animal should be given moder- 



50 LAMENESS OF THE HORSE 

ately free rein. A close grasp on tlie lead may interfere some- 
wliat witli head inoveinents. Xoddin*; of tlie head with the catch- 
ing up of weiglit l)y a sound inenibcr in sui)porting-l('g-laiiieness 
of a fore leg, constitutes the cliief symptom considered in de- 
tecting the lame leg. 

AVhere supporting-leg-lameness affects a hind limb the head 
is raised at the time weight is caught by the sound member — 
here the long axis of the subject's body may be likened unto 
a Wver of the tirst class. The posterior part of the body, at the 
time weight is taken upon the sound leg, is as tlie long arm.- tin- 
fore limbs tlie fulcrum, and the subject's head the weight, wiiich 
is lifted. The head movements of a horse at a trot, in support- 
ing-leg-lameness of a front leg, synchronize with the discharge of 
weight from a lame leg to the opposite one if sound; but in 
pelvic limb affections, the head is thrown or jerked upward as 
weight is caught hy the sound member, — this peculiar nodding 
movement is opposite in the two instances. 

In pacing horses, since front and hind legs of the same side 
are advanced at the same time, there occurs in supporting-leg- 
lameness, a nodding of the head with discharge of weight from 
the lame leg, and a dropping of the hip as weight is caught by 
the sound pelvic member. In observing animals that are limp- 
ing, (as in supporting-leg-lameness) one notices particularly the 
sacro-iliac region in hind leg affections and the occipital region 
in lameness of the front legs. 

"Where there exists a bilateral affection, (such as characterizes 
some cases of navicular disease or other affections causing sup- 
porting-leg-lameness) there occurs no nodding of the head; 
weight is supported for an equal length of time upon each one 
of the two legs, but the stride^ is shortened. The gait, in such 
eases, is peculiar, animals appearing stilV and they are said, by 
horsemen, to have a "choppy" gait. 

It is desira])le, in some cases, to cause an animal to move from 
side to side; in other instances the subject is best made to walk 
or trot in a circle, and if the circle ])e very small the animal 
then particularly employs the inner fore leg as a pivotal sup- 



'T?y stride us me;<nt th<> distance l)etween two successive iniprints of t>.e 
.same foot. The term Is not used in this work as being s.vnonymous with 
step. 



DIAGNOSTIC PRINCIPLES 51 

porting member. To augment the manifestation of certain af- 
fections, it is necessary to cause the patient to walk backward, 
and each one of these tests of locomotion serves to point out 
in a more or less characteristic manner, the site of the affection 
which is causing lameness in different cases. 

Sprains or injuries of lateral ligaments of the extremities, 
ringbone and certain foot affections, are made manifest by a 
side to side movement or a pivotal movement. In fact, wherever 
it is possible to cause undue or unusual tension to be exerted 
upon an inflamed structure, manifestation of pain is the re- 
sponse. In an inflamed condition of the lateral side of the pha- 
langes, unequal weight-bearing such as a rough road surface will, 
by virtue of the leverage which the solar surface of the foot af- 
fords, cause undue strain upon such inflamed parts, and in- 
creased lameness is evident. 

When an animal is made to travel in a circle, when a mem- 
ber affected with supporting-leg-lameness is on the inner side 
of the circle, lameness is accentuated because weight is borne by 
the lame leg for a greater length of time, the result of such cir- 
cuitous manner of locomotion. In swinging-leg-lameness, on 
the other hand, because pain is increased at the time an affected 
member is being advanced, lameness is increased when the sub- 
ject is made to travel in a circle, with the lame leg on the out- 
side of a circle thus described. 

In supporting-leg-lameness, the transientness of the weight- 
bearing period upon the affected member is the deterinining 
factor in the production of lameness. This unecpial period of 
weight-bearing upon the front legs, for instance, causes an ac- 
celeration in the advancement of the sound member, in order to 
relieve the diseased one which is bearing weight. In other words, 
when an animal that is affected with supporting-leg-laineness 
travels in a straiglit line, since weight is borne by the diseased 
leg for an abnormally short period of time, the sound memlier 
needs be in the act of advancement a coi-respondingly short pe- 
riod. The result is then, an unequal division of stride; a nod- 
ding of the head with the catching uj) of weight l)y the sound 
leg, — in front leg affections — and this is termed limping. 

With continuous exertion as in travel for a considerable dis- 



52 LAMENESS OF THE HORSE 

tauce, ill some eases, lameiiess beeonies less evident — as in spavin. 
This "wanning out" process is due in a measure to the parts 
becoming less sensitive upon exertion, and is to be seen, to a 
limited extent, in all iiiHainniatoiy afl'cctions that are not too 
severe; consoiucntly. in some eases, examination of a lame ani- 
mal shouUl bey:in in the stall, for in instances where the impedi- 
jnent is not marked, there may be no evidence of lameness after 
the sul)jeet ha.s walked a few steps. In other eases, lameness in- 
ei'eases as the sul)jeet eontiinies to travel, and often to the ex- 
tent that the impediment becomes too severe to allow the animal 
being serviceable. Therefore, one can not, in every case of lame- 
ness observed, positively determine the gravity of the situation, 
without having seen the affected animal in action for a sufficient 
length of time to understand the nature of the condition ex 
isting. This necessitates driving the animal for several miles in 
certain cases. 

Sometimes it is impossible to arrive at any definite conclusion, 
as the result of a single examination, and it then becomes neces- 
sary to see the subject again at a lat-'r date, or under more 
favorable circumstances. This is to be expected in some con- 
ditions where there exists rheumatic affections, and also in some 
foot diseases. 

In the examination of young animals, unused to harness and 
to other strange incumbrances, one is obliged to make allowance 
for impediments of gait, which are not occasioned by diseased 
conditions. Sucli affections have been termed '"false lameness." 
Young nudes that are not well ])r()ken to harness, are difficult sub- 
jects for examination and in some cases it is necessary to have 
them led ov driven for a considei'able distance Ix'fore one can 
definitely interpret the nature of the impediment in the gait when 
lameness is not pronounced. It is especially difficult to satis- 
factorily examine sucli subjects, for the reason that their normal 
rebellious temperaments cause resistance whenever a strange 
person ai)proaehes them, as it is neeessai-y to do for an examina- 
tion by palpation. In such cases — if an examination does not 
I'eveal the cause of trouble, rest imist be i-econnneiided and fur- 
ther examination made at a later date, whereupon any new 
developments may be noted, if such changes exist. 



DIAGNOSTIC PRINCIPLES 53 

Special Methods of Examination. 

After having c'om])leted a general examination of a lame ani- 
mal — obtaining the history of the case, noting its temperament, 
type, size, conformation, position assumed while at repose, swell- 
ings or enlargements if present, causing the subject to move to 
note the degree and character of lameness manifested ; palpating 
and manipulating the parts affected to a:equire a fairly definite 
notion of the nature of an inflammation or to recognize crepita- 
tion it becomes necessary in some cases to employ peculiar means 
of examination in singular instances. This may be done by mak- 
ing use of cocain in solution for the production of local anes- 
thesia as in lameness of the phalanges. Such means are not, in 
themselves, dependal)le but are valuable when used in conjunc- 
tion with all other available and practical methods. 

Trial use of various shoes in order to shift the weight from 
one part of the foot to another or to cause an animal to "breali 
over" in a different manner so that the gait may be changed, 
constitutes a special test procedure. The use of hoof testers 
or of a hammer to note the degree or presence of supersensi- 
tiveness is another means that is of practical service. No exam- 




Pig-. 1 — Hoof testers with special jaws of sufficient size to grasp the 
largest foot. 

ination, in any case of lameness, is complete without having re- 
moved the shoe and scrutinized the solar surface of the foot. 

Diagnosis by exclusion, finally, is resorted to, and, as in any 
other case where the recognition of cause is difificult, exclusion 
of the existence of conditions, — one at a time, by an analysis 
of sjnnptoms — generally enables the practictioner to eliminate all 
but the disturbing element. 



SECTION III. 
LAMENESS IN THE FORE LEG. 

Anatomo-Physiological Review of parts of the Fore Leg. 

For supporting weight, wliether tlie subject is at rest or in 
motion, the bony column of the leg, together with attached liga- 
ments, tendons and muscles, is wonderfully well adapted by na- 
ture for the function which they perform. The several bones 
which go to make up the supportive portion of the leg, are so 
joined at their points of articulation, that a minimum degree 
of strain is put upon each attachment. 

The upper third of the scapula, with its cartilage of prolonga- 
tion, is sufficiently broad and flattened that it fits snugly against 
the thorax without necessity for a complicated method of attach- 
ment — the clavicle being absent, attachment is nuiseular. 

Smith^ has very aptly stated that : 

' ' It seems quite legitimate to regard the nuiseular union between 
the thorax and forelimb as a joint. There are no bones resting 
on each other, no synovia; but where the scapula has its largest 
range of movement there is a remarkable amount of areolar 
tissue, which renders movement easy. The whole central area 
beneath the scapula and humerus not occupied by muscular at- 
tachment, is filled with this easy-moving, apparently gaseously 
distended, crepitant, areolar tissue over which the fore legs glide 
on the chest wall as freely as if the parts were a large, well 
lubricated joint." 

The scapulohumeral articulation (shoulder joint) is an 
enarthrodial (ball and socket) joint but l)ecause of its being 
held more or less firmly against the thoracic wall by muscular 
and tendinous attachment, and liecause a part of this attachment 
affords a means of support for the liody itself, there is no need 
for binding ligaments and movement is j^ossible in all directions 
even though restricted as to extent. 

'Manual of Veterinary Physiology, by Major-General F. Smith, page 590. 

55 



56 



LAMENESS OF THE HORSE 



Extensor cnrjri ohliquui, 



Metacarpal tuberosity 
Tendon from common to lateral extensor 



Lateral small metacarpal bone 



Branch of suspensory ligament to 
extensor tendon 




Olecranon 



Ulnar head of deep flexor 



Lateral extensor 
Deep flexor {humeral head) 



Tendon of ulnaris lateralis 
Accessory carpal bone 



Check ligament 



Suspensory ligament 
Flexor tendons 



Flexor tetidons 
Carlilnge of third phalanx 



r T.ft Thoracic T>iinb from Klbow DoNNnNvard; Lateral 
pjg 2— Muscles of Left Thoiacit i^im 

(External) View. ,.,..„ hriohialis- k' anterior superlicial pectoral: 

a. Extensor carpi radialis, g. ^^^^ '^^'.•,;„ j^ (After Ellenborger-Baum, 



LAMENESS IN THE FORE LEG 



57 



Long head of triceps 
Medial head oj triceps 

Olecranon 
Ulnar head of deep flexor - 



Flexor carpi ulnaris 
Flexor carpi radialis - 



Biceps brachii 



Extensor carpi radialis 
■ Long tendon of biceps 
Brachialis 
Long medial lignmcnl 



Radius 



Acce.tsory carpal hone 
Media] ligament of carpus 



Tendon of extensor carpi 
obliquus 

Metacarpal tuberosity 



Superficud flexor tendon 

Deep flexor leruion 
Suspensory ligament 

Distal end of Mc. II 
Anniihr ligament 

Superficial flexor tendon 
Deep flexor tendon 



'W 



Mc. Ill 



Fetlock joint 

Extensor branch of suspensnrii 
ligameTU 

■ Co7n7non extensor tendon 

■ Pastern joint 



— Cartilage of third phalanx 



Fig. 3— Muscles of Left Thoracic Limb from Llbow Ilowiuvaid; Medial 
(Internal) View. 

The fascia and the ulnar head of tiie flexor carpi ulnaris have been re- 
moved. 1, Distal end of humeru.s; 2, median vessels and nerve. (From 
Sisson's "Anatomy of the Domestic Animals"). 



58 LAMENESS OF THE HORSE 

I'ikIuc exli'iision, (liy cxteiisioii is moiint sucli niuvenioiit as 
will cause the long axis of two articulating bones to assume a 
position which approaches or forms a straight line — opposite to 
flexion), of the scapulohumeral joint is impossible while weight 
is borne, because of the normally flexed position of the humerus 
on the scapula ; whereas fiexion, beyond desirable limits, is in- 
hibited by the biceps brachii (flexor brachii or coracorndialis) 
muscle. 

The distal end of the humerus, however, articulating with the 
radius and ulna in a fashion tliat no supjiort is lent by any sort 
of contact with the body, is a giiiglymus (hinge) joint and later- 
al motion, because of the long transverse diameter of its articular 
])orti()ns, is easily prevented by tlie medial and lateral ligaments 
(internal and external ligaments). Flexion of this, the iuimero- 
radioulnar joint (elbow), is restrained by the triceps ])rachii 
and extension is checked by the ])iceps brachii (flexor brachii). 

The carpal joint (erroneously called the knee joint), is com- 
posed of the several carpal bones which interarticulate and, 
when taken as a group, serve as a means of attaclnneiit and ar- 
ticulation for the radius and metacarpal bones. 

The transverse diameter of this joint is long, thus giving it 
contacting surfaces that are sufficiently extensive to minimize 
the strain upon the mesial and lateral ligaments (internal and 
external lateral common ligaments). ^Motion is that of flexion 
and extension; slight rotation is possible when the ]>osition is 
that of flexion. While supporting weight the carpus is fixed in 
position by a slight dorsal flexion, but undue dorsal flexion is 
prevented by the flexor muscles and tendons and volar-carpal or 
annular ligament, together with the superior check ligament. 

The metacarpophalangeal articulation (fetlock joint), is a 
hinge joint and its articular surfaces contact one another, with 
respect to their having a long bearing .surface from side to side, 
as do all ginglymus (hinge) j(>ints. Two common lateral liga- 
ments bind the bones together. While bearing weight, there is 
assumed a position of slight dorsal flexion, undue flexion being 
checked by the inhibitory ajiiniratus of the joint — check liga- 
ments, and their tendons and the suspensory ligament. The in- 
hibitory apparatus of the fetlock joint is materially reinforced 



LAMENESS IN THE FORE LEG 



59 



by the proximal sesamoid bones. Situated as they are, between 
the bifurcating portions of the suspensory ligament and the pos- 
terior part of the distal end of the metacarpus — with which they 
articulate — the sesamoid bones serve to chnns'i' tlic course of the 



Skin 

Tendon of common exlenso; 

Bursa 

Capsule of fetlock joint 
Canty of fetlock Joint 



Cavity of jinslcrn joint 



Cavity of coffin joint 



Corium of pcrioplc 
Perioplc 

Coronary corium 

Wall 

LamincE 





Middle srsamoideaii Ugamcnt 
Digital synovial shcalh 
Cavity of pastern joint 
Superficial sesamoidean ligament 
Deep flexor tendon 
Distal end of digital sheath 



Digital cushion 



\ Drrp ftrxor ^-' f'OQ 



Dcrp fli xor 
titidon 



rum of sole 



Fig. 4— Sagital Section of Digit and Distal Part of Metacarpus. 

A, Metacarpal bone; B, fir.st phalanx; C, second phalanx, D, third phalanx; 
E, distal sesamoid bone; 1, volar pouch of capsule of fetlock joint; 2, inter- 
sesamoidean ligament; 3, 4, proximal end of digital synovial sheath; 5, 
ring formed by superficial flexor tendon; 6, fibrous tissue underlying ergot; 
7, ergot; 8, 9, 9', branches of digital vessels; 10, di.'stal ligament of distal 
sesamoid bone; 11, suspensory ligament of distal sesamoid bone; 12, 
12', proximal and distal ends of bursa podotrochlearis. (From Sisson's 
"Anatomy of the Domestic Animals"). 

branches of the suspensory ligament in a manner that they give 
firm support to this joint. Volar flexion is limited by the ex- 
tensors of the phalanges. 

The first phalanx (os suffraginis) normally sets at an angle 



60 LAMENESS OK THE HORSE 

of about r)0 to .").") (Ii'iji'ccs t'l'oiii a horizontal plane wiiilc weight 
is being supported, its distal end articulates with the second or 
median phalanx (os corona) anil forms the pi'oxinud inter- 
phalangeal (pastern or suffraginoeoronary) joint. This also, 
is a ginglynms joint, havini; but slight lateral motion, and that 
only when it is in a state of Hexion. A rather l)road articular 
surface — from side to side — exists here, lessening the strain 
on the collateral ligaments somewhat. Dorsal flexion is cheeked 
by the flexor tendons and dorsal ligaments. Volar tiexion is re- 
strained by the extensor tendons. 

The distal end of the second phalanx (os corona) has but slight 
lateral motion and this is manifested principally when it is in 
a state of volar flexion. Undue dorsal flexion is prevented by 
the deep flexor tendon (perforans) and volar flexion is inhibited 
by the extensor of the digit (extensor pedis). Thus it is seen, 
that when the leg is a weight-bearing member, weight is sup- 
ported by the bony framework whose constituent parts are joined 
together by ligaments and tendons and each one of the several 
bones articulates in such manner that the joint is locked. The 
articular ])arts of bones rest upon or aorainst an inhibitory ap- 
paratus, and are slightly flexed, as in the carpus, or considerably 
flexed such as in the fetlock joint when weight is being sup- 
ported. Tn the first instance, for example, the flexors of the 
carpus and the superior cheek ligament a.ssisted b.v the flexors 
of the phalanges constitute the inhibitory apparatus. 

Tt wnll be noted that provision for weight bearing is so ar- 
ranged that muscidar energy is not required except in the matter 
of susi)ension of the body between the scapulae and Ikm'c tonic 
impulses only are necessary to maintain an equilibrium\ yet 
in every instance where weight is not supported by bones, in- 
elastic ligaments or tendinous structures relieve the nnisculature 
of this constant strain. This ex|)lains the fact that some horses 
do not lie in the stall, yet in spite of their constant standing 
jiosition. they are able to rest and sleep. 

The student of lameness is interested in the function of the 
legs in the rol(> of supporting wcMglit and as propelling parts, 
and net paiticnlarly in the ea|)aeit.v of these members for in- 



'Miiiuial r.f \'Mieriii:u\- I'hy.sioloKv li\ .Major-Ceneral F. Smith, page tiSU. 



LAMENESS IN THE FORE LEG 61 

flicting offense or as weapons of defense. Yet, in the exercise of 
their functions other tlian that of locomotive appliances, injury 
often results, but usually it is the recipient of a blow that suffers 
the injury, such as an animal may receive upon being kicked. 
Therefore, we do not often concern ourselves with strains or other 
injuries that the subject experiences as the result of efforts put 
forth in kicking or striking. Where such injuries occur, how- 
ever, a diagnosis is esta])lished by making use of the principles 
heretofore discussed. 

As propelling members the front legs bear weight and are 
advanced alternately when the horse is walking or trotting — in 
cantering this is not so. When the normal subject travels in a 
straight line, at a walk or a trot, the length of the stride is the 
same with the right and left members. The stride of the right 
foot then, for example, is equally divided l)y the imprint of the 
left foot, in the normal horse, when traveling at a walk and in 
a straight line. 

Shoulder Lameness. 

This enigmatical term is frequently employed by the diag- 
mostician when he is baffled in the matter of definitely locating 
the cause of lameness; when he has by exclusion and otherwise 
arrived at a decision that lameness is "high up." Shoulder 
lameness may be caused by any one or several of a number of 
conditions, e. g., fractures of the scapula or humerus; arthritis 
of the shoulder or elbow joint ; luxation of the shoulder or elbow 
joint (rarely) ; injuries of muscles and tendons of the region due 
to strains, contusions or penetrant wounds; paralysis of the 
brachial plexus or of the prescapular nerve; involvement of 
lymph glands; arterial thrombosis; metastatic infections; rheu- 
matic disturliances ; and as the result of inflannnation, infectious 
or non-infectious occasioned by collar bruises. In some instances 
such inflammation is due to the manner of treatment of collar 
injuries. Therefore, when one considers the luimerous and dis- 
similar possible causes of shoulder lament^ss, it IjcIioovcs the prac- 
titioner to become ]iroficient in diagnostic pi'inciples. 

A principle which is elemental in the diagnosis of locomotory 
impediment, is that lameness of the shoulder or hip is usually 



62 



LAMENESS OF THE HORSE 



manifested by more or less difficulty in swinging the affected 
member. Swinging-leg-lameness, then, is usually present in 
shoivlder affections. In some instances lameness is mixed as in 
joint ailments, involvement of tlie bicipital bursa (l)ursa inter- 
tubcrcularis), etc. In affections of the extremity there exists 
supporting leg lameness. Consequently, we employ this ele- 
mental principle, and, by a visual examination of the subject, 
which is being made to travel suitably, one may decide that 
lameness is either '"high up" — shouhler lameness or, "low 
down" — of the exti-emity. 




Fig. 5 — Ordinary type of heavy sling. 



To make practical use of this i)rinciple. Ilie t-xaminer nuist 
be thoroughly familiar with the anatomy of the various struc' 
tures concerned in advancing the leg — those which supj^ort weight 
as well as those concerned both in weight bearing and swinging 
the member. 

Fracture of the Scapula. 

Etiology and Occurrence. — Fractures of the l)ody of the 
scapula are of infrequent occurrence in horses for the reason 



LAMENESS IN THE FORE LEG 



63 



that protection is afforded this bone because of its position. Its 
function, too, is such that very unusual conditions are necessary 
to subject it to fracture. The spine is occasionally broken due 
to blows such as kicks, etc., and here frequently a compound 
fracture exists. 

Where fractures of the body of the scapula occur, heavy con- 
tusions have been the cause as a rule, and serious injury is done 
the subject; consequently, treatment of fracture of the body of 




Fig. 6 — A sling made in two parts so that horses may be supported with- 
out use of central part or bodice. This sling is more comfortable than 
is the ordinary style and is particularly useful in cases that require a 
long period of this manner of confinement. 

the scapula is seldom successfully practised. Fractures of the 
body of this bone resulting from accidents not involving internal 
injury or other disturliances and which would not seriously inter- 
fere with the vitality of the sul)ject, are not necessarily serious 
unless compound. 

Fractures of the neck of the scapula are serious because of 
the fact that there occurs displacement of the broken parts and 



64 LAMENESS OF THE HORSE 

perfect apposition of the fractured ends is difficult, if not iin 
possible. 

Fractures that extend to the articular surface are very seri- 
ous, and complete recovery in such instances is practically impos- 
sible. The cartilage of prolongation of the scapula is sometimes 
seriously involved in certain cases of fistulous withers, and in 
some instances it has been separated from its attachment to the 
rhoiiihoidca muscles, and lameness has resulted. In such in- 
stances, the ui^per portion of the scapula is disjoined from all 
attachment, and with every movement the animal makes, the 
scapula is moved back and fortli. Complete recovery in such 
cases does not occur. 

Symptomatology. — Fractures of the scapular spine are ordi- 
narily readily iccdgnized because there is usually visible dis- 
placement of the broken part. Crepitation is also detected with- 
out difficulty. 

In fractures of the body of the scapula whci'c an examination 
nuiy be made before imieh swelling has tal\en i)lace, and in sub- 
jects that ai'c not heavily muscled, one should have no difficulty 
in recognizing the crepitation. 

Fractures of the neck of the scapula are recognized by crepi- 
tation, liy passively moving the leg, but it is necessary to exclude 
fractures of the humerus when one depends upon the finding of 
crepitation by this means. However, unless undue swelling ex- 
ists, the exact location of the crepitation is recognized without 
serions difficulty. 

Treatment. — The treatment of coinpound fractures of the 
scapular spine consists in the removal of the broken piece of 
bone by way of a cutaneous incision so situated tliat good drain- 
age of the wound will follow. 

Simple fractures of the body of the scajuila are best treated 
by placing the subject in a sling, if the animal is halter broken, 
and enforcing absnlnte quiet for a period of fi-om three to six 
weeks. S])Unts or similar appliances are not of practical value 
in scapular fractures. 

Comjtound fractures of the scapula usually rcNult from vio- 
lence, which at the same time does serious injury to adjacent 



LAMENESS IN THE FORE LEG 65 

structures, and it then becomes necessary to administer an ex- 
pectant treatment, observing general surgical principles and pro- 
viding in so far as possible for the comfort of the patient. 

Scapulohumeral Arthritis. 

Anatomy. — The scapulohumeral joint is an enarthrodial (ball 
and socket) joint wherein the ball or humeral articulating head 
greatly exceeds in size the socket or glenoid cavity of the scapula. 
The capsular ligament surrounding this joint is very large and 
admits of free and extensive movement of the articulation. There 
exist no lateral or common ligaments jointing the scapula and 
humerus as in other joints, but instead the tendinous portions 
of muscles perform this function. The principal ones which are 
attached to the scapula and humerus that act as ligaments are 
the supraspinatus (antea-spinatus), infraspinatus (postea- 
spinatus) biceps-brachii (flexor brachii) and subscapulars mus- 
cles. 

Etiology and Occurrence. — Inflammation of the scapulohum- 
eral articulation results from injuries of various kinds, including 
punctures which perforate the joint capsule, bruises from col- 
lars, metastatic infections and involvement as a result of direct 
extension of infectious conditions situated near the joint. 

Classification. — Acute arthritis may be septic or aseptic, and 
there seems to l)e a remarkable tendency for recovery in cases 
of septic arthritis involving this joint in the horse. 

Chronic arthritis with destruction of articular surfaces and 
ankylosis, is seldom observed. It is only in cases of severe in- 
jury, where the articular portions of the l)ones are damaged at 
the time of infliction of the injury, and where the articulation 
remains exposed for weeks at a time, together with immobility 
of the parts because of attending pain, that permanent ankylosis 
results. 

Scapulohumeral ai'thritis may result then from infections, local 
or metastatic; from hi juries, such as contusions of various kinds; 
from wounds, which break the surface structure or perforate 
the joint capsule ; or from luxations. 



66 LAMENESS OF THE HORSE 

Infectious Arthritis. 

Infectious arthritis of the scapulohumeral joint the result of 
local causes other than produced by septic wounds, seldom causes 
serious inconvenience to the subject. Where such occurs, how- 
ever, there is manifested mixed lameness and complete extension 
of the extremity is impossible. Local swelling is present and 
manifestations of pain are evident n\nm palpation of the affected 
area. 

Treatment. — During the first stage of the infection, local ap- 
I)licatious, hot or cold, are indicated, A hot poultice of bran 
or other suitable material contained within a muslin sack, may 
be supported by means of cords or tapes which are passed over 
the withers and tied around the opposite fore leg. Such an 
appliance may be held in position more securely by attaching 
it to the affected member. Following the acute stage of such an 
infection, any local counter-irritating application or even a 
vesicant is in order. 

"Where abatement of the infectious process does not take place, 
and suppuration of the structures in the vicinity of the joint 
occui-s, it is necessary to provide drainage for pus. In some 
cases of strangles, for instance, large pus cavities are formed 
and drainage is imperative. However, metastatic intlamination 
of this joint is seldom observed except in ca.ses of strangles. 
The animal should be kept perfectly quiet until recovery has 
taken place. 

Injuries. 

Injuries to the scapulohumeral joint may be the result of 
kicks, runaway accidents or bruises from the collar, and there 
may result, because of such injuries, reactionary inflammation 
wliich will vary in intensity from the mildest synovitis to the 
jiiost severe arthritis, causing more or less lameness. 

Treatment. — The general plan of treatment in this form of 
arthritis is the same as has been outlined under the head of in- 
fectious arthritis, with the exception that there is seldom occa- 
sion to provide for drainage of pus. 



LAMENESS IN THE FORE LEG 67 

Wounds. 

Wounds which cause a break of the skin and fascia overlying 
the scapulohumeral joint are usually of little consequence, unless 
the blow is of sufficient force to directly injure the articulation, 
and in such cases, the treatment of the injury along general sur- 
gical principles, such as cleansing the area, providing drainage 
for wound secretion, and the administration of suitable dress- 
ing materials such as antiseptic dusting powder, is all that is 
required for the wound. The symptoms manifested by the sub- 
ject in such cases are the same as have been discussed hereto- 
fore and merit no special consideration. 

Prognosis. — Unless very serious injury be done the articular 
portions of the scapula or the humerus, resulting in the destruc- 
tion of the capsular ligament, prognosis is entirely favorable. 

Open Joint. — Where the capsular ligament is perforated and 
the condition becomes one of open joint, then a special wound 
treatment becomes necessary. The surface of the skin is first 
freed from all hair and filth in the vicinity of the wound. The 
wound proper is cleared of all foreign material either by clipping 
with the scissors, curetting or mopping with cotton or gauze 
pledgets. The whole exposed wound surface as well as the in- 
terior of the joint cavity, if much exposed, is moistened with 
tincture of iodin. Subsequent treatment consists in a local appli- 
cation of a desiceant dusting powder, which should be applied 
five or six times daily. The composition of the powder should 
be such as to permit of its liberal use, thereby affording mechan- 
ical protection to the wound as well as exerting a desiccative 
effect. Equal parts of boric acid and exsiccated alum serve 
very well in such cases. 

Animals suffering from open joints of this kind should be 
confined in a standing position, preferably in slings, and kept 
so confined for three or four weeks. Since they usually bear 
weight upon the affected member, there is no danger of lamin- 
itis resulting. 

Luxation of the Scapulohumeral Joint. 

Because of the large humeral head articulating as it does with 



68 LAMENESS OF THE HORSE 

a glenoid cavity, scapulohumeral luxations are very rare in the 
horse. According to ]\Ioller\ luxation is generally duo to exces- 
sive flexion of the scapulohumeral joint. In such cases the head 
of the humerus is disjjlaccd anterior to the articular jwrtion of 
the scapula and remains so fixed. 

Symptoms. — Complete luxation of the scapula is recognized 
hecause of immobility of the seapuloluimeral joint and of the 
abnormal position of the head of the humerus, which can be rec- 
ognized by palpation, unless the swelling be excessive. Immo- 
bility of the scapulohumeral joint is noticeable when one attempts 
to pas.sively move the parts. 

Treatment. — Reduction of the luxation is effected l)y mak- 
ing use of the same general principles that are employed in the 
reduction of all luxations, and they are — the control of the ani- 
mal so that the manipulations of the operator are not antagon- 
ized by nuiscular contraction, which is best accomplished by 
anesthesia ; placing the luxated bones in the position wliich they 
have taken to become unjointed; and then making use of force 
which is directed in a manner opposite to that which has effected 
the luxation. 

In a forward luxation of this kind, the operator should further 
flex the humerus, and while it is in this flexed position, force is 
exerted upon the articular head of this bone, and it is pushed 
downward and backward into its nornuil position. 

After-care consists in restriction of exercise and, if necessary, 
confining the subject in a sling and the application of a vesicant 
over the scapulohumeral region. 

Inflammation of the Bicipital Bursa. 
( Bursitis Intertubercularis. ) 

Anatomy. — Tliere is interposed ])etween tlie tendon of tlie 
biceps bi-achii (flexor brachii) and the intertul)ercular or bicipi- 
tal groove a heavy cartilaginous pad, which is a part of the bursa 
of the biceps brachii. This synovial bursa forms a smooth groove 
through which tlie biceps brachii glides in the anterior scapulo- 

'Iteeional Veterinary Surgery and Operative Teclinique, .Iiio. A. W. Dollar, 
M. H. C. V. S., F. U. S. E., M. R. I., page 765. 



LAMENESS IN THE FORE LEG 69 

humeral region. Great strain is put upon these parts because 
the biceps brachii is the chief inhibiting structure of the scapu- 
lohumeral articulation — the one which prevents further flexion 
of the humerus during weight bearing. Passing, as it does, over 
two articulations, the biceps brachii has a somewhat compli- 
cated function, being a flexor of the radius and an extensor of 
the humerus. Thus it is seen, the biceps brachii is a weight bear- 
ing structure, as well as one that has to do with swinging the leg. 
Etiology and Occurrence. — Because of the exposed position 
of the bicipital bursa (bursa-intertubercularis) it is occasionally 
injured. Blows and injuries received in runaway accidents do 
serious injury to the bursa and because of the peculiar and im- 
portant part it plays during locomotion, serious injuries are 
not likely to resolve, and too often chronic lameness results. It 
is to be noted that the tendon of the biceps brachii (flexor bra- 
chii) is always involved in cases of inflammation of the bicipital 
bursa, and according to the late Dr. BelP strain of the biceps 
brachii is a frequent cause of lameness in city horses, more fre- 
quent than is generally supposed. 

Pathological Anatomy. — More or less destruction of the car- 
tilaginous portion of the bursa, sometimes involving the tendin- 
ous portion of the biceps, takes place and, according to Moller, 
in some instances there occurs ossification of the tendon. Autop- 
sies in some old horses reveal the presence of erosions of carti- 
lage and hyperthrophy of the inflamed parts. 

Symptoms. — In acute inflammations, there is always marked 
lameness. This is manifested to a greater degree when the sub- 
ject advances the affected leg. There is incomplete advancement 
of the member; the toe is dragged when the horse is made to 
walk and the foot kept in a position posterior to the opposite or 
weight bearing foot while the subject is at rest. Lameness is 
disproportionate to the amount of local manifestation in the way 
of heat, swelling and pain that is to be recognized on palpation. 
In fact, in some cases so much pain attends the condition that 
no weight is borne by the affected meml)er, and when compelled 
to walk, the subject hops on the sound leg. 



'Dr. Roscoe R. Bell in the Proceedings, N. Y. State Veterinary Medical 
Society, 1S99. 



70 LAMENESS OF THE HORSE 

Chronic iufianiniation of tlie bicipital bursa is occasionally met 
with wherein both members are affected. Because of the nature 
of the structures involved, when inflamed, chronic inflammation 
is a more frequent termination than is complete recovery. Bi- 
lateral affections are seen in horses that are driven for years, 
regularly at a fast pace on paved streets. In such cases, the 
gait is stilted, that is, there is incomplete advancement of both 
members and, of course, the period of weight bearing is cor- 
respondingly shortened; hence the short strides. 

In chronic cases, little if any evidence of inflammation is to 
be detected by digital manipulation of the parts. If flinching 
occurs, one is often unable to interpret the manifestation as to 
whether it is due to inflammation or not. 

There is no marked "warming out" in this condition, and ani- 
mals are nearly as lame after having boon driven a considerable 
distance as when started, althoiiuli the lameness is not as a rule 
very great. 

Treatment. — In very painful cases acute inflammation is 
treated ])y employing cold applications during the initial stage. 
Cracked ice when contained in a suitable sack may be held in 
contact with the affected part and the pack is supported by 
means of cords or tapes as suggested in the discussion on treat- 
ment of scapulohumeral arthritis on page 66. Later, hot appli- 
cations may be employed to good advantage. 

in the course of ten days or two weeks, if the acute painful 
condition has entirely subsided, vesication is indicated. The 
ordinary mercury and cantharides combination does very well. 
Depending upon the course taken in any given case, one is guided 
in the treatment employed. If prompt resolution comes to 
pass, the subject may be given free run at pasture after three 
or four weeks confinement in a box stall. If, however, the case 
does not progress in a prompt and satisfactory manner, abso- 
lute quiet must be enforced for six weeks or more. Repeated 
blistering is beneficial, although it is doubtful if firing is of 
sufficient benefit in the average chronic case of intertubercular 
bursitis to justify the punishment which this form of treatment 
inflicts, unless infliction of pain is the thing sought, to en- 



LAMENESS IN THE FORE LEG 71 

force repose in restless subjects. Patients are best given a long 
rest at pasture and returned to work for two or three months 
after an acute attack of inflammation of the bursa, lest the con- 
dition become chronic. When due consideration is given the 
pathology of such cases, the frequent unsatisfactory termination 
under the most careful treatment, is readily understood. 

Contusions of the Triceps Brachii. 
(Triceps Extensor Brachii: Caput Muscles.) 

Anatomy. — The triceps brachii is the principal structure 
which fills the space between the posterior border of the scapula 
and the humerus. The several heads originate for the most part 
on the border of the scapula, the deltoid tuberosity of the hu- 
merus and the shaft of the humerus. Insertion of this large 
muscular mass is effected by means of several tendons to the 
olecranon. A synovial bursa is situated underneath the ten- 
dinous attachment of the posterior portion of the triceps brachii 
— the long head or caput magnum. 

The function of the triceps as a whole is to flex the shoulder 
joint and extend the forearm. The triceps brachii is the chief 
antagonist of the biceps brachii. 

Etiology and Occurrence. — Owing to the exposed position of 
this structure, it is not infrequently contused, the result of falls, 
kicks and other injuries. The function of the triceps is such 
that it becomes strained upon rare occasions when a horse resists 
confinement of restraint in such manner that the parts are un- 
duly tensed in contraction. This sort of resistance may stretch 
the radial nei've or its branches in a way that paralysis results. 
A condition known as "dropped elbow" is described by Henrj'' 
Taylor, F. R. C. V. S., in the Veterinary Record^ wherein a 
two-year-old colt while resisting confinement was so injured. 

The triceps group because of its convenient location, consti- 
tutes the site for hypodermic injection of drags and biologic 
agents, with some practitioners; and as a result, more or less 
inflammation may occur. The author has ol)served and treated 
some twenty cases where an intensely painful infectious inflam- 

lAmerican Veterinary Review, Vol. 35, P. 456. 



72 LAMENESS OF THE HORSE 

mation of tlic trici'ps l)rat'liii was caused l)y the iiiti-aniuscular 
injection of a eaustic solution hy a crud and unscrupulous cm 
pirie, Avhose object was to increa.se his practice. 

Sjrmptomatology. — As the triceps brachii is not particularly 
taxt'd duiin^f wci^dit bearing in the su])jcct at rest, there may 
be no unnatural position assumed during inflammation of the 
triceps. ^More or less swelling and supcrsensitiveness is always 
present, however, and great care and discrimination nnist be ex- 
ercised in digital manipulation of the triceps region because 
many animals are normally sensitive to palpation of these parts. 
It is sometimes difficult to correctly interpret the true state of 
conditions because of this peculiarity. 

There is always swinging-leg-lameness, which is accentuated 
when the subject is urged to trot. "Where symptoms are pro- 
nounced, it is unnecessary to cause the subject to move at a 
faster pace than at a walk to recognize the condition. The for- 
ward stride is shortened and in extrendey painful conditions, no 
attempt is made to extend the leg. It is simply carried en une 
piece — flexion of the shoulder and elbow joints is carefully 
avoided. 

Treatment. — During the early stage of inflammation, hot or 
cold applications are beneficial. Long continued use of moist 
heat — fomentations — allays pain and stinuilates resolution. Keep- 
ing in contact with the painfully swollen parts a suitable bag 
filled with bran, which can be moistened at intervals with warm 
water, constitutes a practical and easy means of treatment. By 
em])loying this method, one is more likely to succeed in having 
his patient i)roperly cared for, in that less work is entailed than 
if hot fomentations are prescril)ed. 

After the acute and painful stage has sul)sided. a stimulating 
liniment is of benefit. The .subject should be kept within a com- 
fortable and roomy box stall for a sufficient length of time to 
favor prompt resolution. AVild and nervous subjects, if not so 
confined, will probably overexert the affected parts if allowed 
the freedom of a paddock or pasture. 

"Where the inflammation becomes infective, surgical interfer- 
ence is necessary. The prompt evacuation of pus, with adequate 



LAMENESS IN THE FORE LEG 73 

provision for wound discharge, should be attended to before 
extensive destruction of tissue takes place. Resolution is prompt 
as a rule in such cases because of the vascularity of the struc- 
tures and the ease with which proper drainage may be effected. 
No special after-care is necessary if drainage is perfect, ex- 
cept that one should avoid injecting the wound cavity with 
aqueous solutions unless it be absolutely necessary to cleanse 
such cavity, and then it is best to swab the wound rather than 
to irrigate it freely. 

Shoulder Atrophy. 
(Sweeny or Swinney) 

No satisfactory consideration of the pathogeny of this condi- 
tion is recorded, but practitioners have long distinguished be- 
tween muscular atrophies which are apparently caused without 
doing serious injury to nerves and muscular atrophy which 
seems to be due to nerve affection. In the first instance, recov- 
ery when proper attention is given, is prompt ; whereas, in the 
latter, regeneration of the wasted tissues requires months in 
spite of the best sort of treatment. 

The parts more frequently affected are the supra- and infra- 
scapularis (antea- and posteaspinatus) nmscles. But in some 
cases the triceps group is involved ; however, this occurs in un- 
usual and chronic affections. No doubt, these chronic cases are 
due to suspended innervation and are uot to be classed with 
the ordinary case of atrophy of the abductor muscles of the 
humerus (supra- and infraspinatus) as in the usual case of 
' ' sweeny. ' ' 

Occurrence. — Shoulder atrophy such as the general practi- 
tioner commoiily meets with, is an affection, more often seen in 
young animals and it seems to be due to injuries of various kinds 
which contuse the muscles of the shoulder. Ill-fitting collars 
and pulling in a manner that there occurs side draft with un- 
usual strain on the muscles of one side of the neck and shoulder, 
seem to ])e the more frequent causes of this trouble. Blows such 
as are occasioned by kicks and falls fro(|uent]y result in atrophy 
of shoulder muscles. 



74 LAMENESS OF THE HORSE 

Course. — In some cases a rapidly i)rogressive atrophy char- 
acterizes tlie ease and lameness and atrophy appear at about 
the same time. The affection in such instances does not re- 
cover spontaneously but constitutes a condition which re(]uires 
prompt and rational treatment so that function may be fully 
restored to the parts involved. 

Occa.sionally one may observe cases where there is but sli^,dit 
atrophy; where the disease progresses slowly and atrophy is 
not extensive or marked. In vigorous young animals that are 
left to run at pasture when so mildly affected, spontaneous re- 
covery occurs. 

Symptomatology. — Lameness is the first manifestation of 
shoulder atrophy, and in many cases where lameness is slight, 
the veterinarian may fail to discover the exact nature of the 
trouble if he is not very proficient as a diagnostician of lame- 
ness or if he is careless in taking into consideration obtainable 
history, age of the subject, etc. Because of the fact that the 
average layman believes that practically every case of fore-leg 
lameness wherein it is not obvious that the cause is elsewhere, 
is due to a shoulder affection of some kind, we may be too hasty 
in giving the client a.ssurance that no "sweeny" exists. In some 
of these cases where a diagnosis of "shoulder lameness" has 
been made and the client has been assured that no sweeny exists, 
tiie patient is returned in about a week and there is then marked 
atrophy of one or both of the spinatus muscles. 

A mixed type of lameness characterizes this affection, and in 
the average case there exists little evidence of local pain. The 
salient points in recognizing the condition are a consideration 
of hi.story if obtainable; age of the subject; finding slight local 
soreness, by carefully manipulating the nniscles which are usu- 
ally involved; noting the character of the lameness if any is 
pi-esent ; and where atrophy is evident, of course, the true con- 
dition is obvious. 

Treatment. — Subcutaneous injections of e(|ual i)arts of re- 
fined oil of turpentine and alcohol, with a suitable hypo- 
dermic syringe, is a practical and ordinarily effective treatment. 
From five to fifteen cubic centimeters (the quantity varies with 



LAMENESS IN THE FORE LEG 75 

the size of the animal), of this mixture is injected into the atro- 
phied parts at different points, taking care to introduce only 
about one to two cubic centimeters at each point of injection. 
The syringe should be sterile and, needless to say, the site of 
injections must be surgically clean. 

Other agents, such as tincture of iodin, solutions of silver 
nitrate, saline solutions and various more or less irritating prep- 
arations have been employed ; but in the use of these preparations 
one may either fail to stimulate sufficient inflammation to cause 
regeneration to take place, or infection is apt to occur. Where 
suppuration results, surgical evacuation of pus must be promptly 
effected else large suppurating cavities form. 

The employment of setons constitutes a dependable method of 
treatment of shoulder atrophy, but because of the attendant sup- 
purative process which inevitably results, this method is not 
popular with modern surgeons and is a last resort procedure. 

After-care. — Regular exercise such as the horse usually takes 
when at pasture, is very helpful in treating atrophy, and in some 
cases it has been found that no reasonable amount of irritation 
would stimulate muscular regeneration; but by later allowing 
patients to exercise at Avill, recovery took place in a satisfactory 
manner. No special attention is ordinarily necessary. 

PareJysis of the Suprascapular Nerve. 

Anatomy. — The suprascapular (anterior scapular) nerve, a 
small branch of the brachial plexus, is given off from the an- 
terior portion of this plexus. The nerve rounds the anterior 
border of the neck of the scapula, passing upward and backward 
under the supraspinatus (antea-spinatus) muscle and terminat- 
ing in the infraspinatus (postea-spinatus) muscle. 

Etiology and Occurrence. — As the result of direct injury to 
this nerve by contusion such as may be received in runaway 
accidents, collar bruises, especially collar bruises in young horses 
that are not accustomed to pulling and that walk in a manner 
to cause side draft, injury to the nerve occurs, and partial or 
complete paralysis supervenes. Some writers state that it may 
be produced by confining an animal in recumbency, with the 



76 



LAMENESS OF THE HORSE 



casting harness. The common cause of paralysis or paresis of 
this nerve in cases sneh as one observes in country practice, is 
])ruisos from the colhu* in colts that are put to heavy farm work 
1)1- wlici'c ill fitting collars are used. 

Symptomatology. — AVith partial or complete suspension of 
function of the su{)rascapular nerve thei-e results enervation 
of the supraspinatus and infraspinatus muscles. Since these 
muscles act as external lateral ligaments 
of the scapulohumeral joint, when they 
are incapacitated, there naturally fol- 
lows more or less abduction of the 
shoulder when weight is borne. 

In extreme cases, as soon a.> the ailing 
animal is caused to support weight with 
the atfected member, the joint is sud- 
denly throw^n outward in a manner that 
the average layman at once concludes 
that there must be scapulohumeral luxa- 
tion, and the veterinarian receives a call 
to see a case wherein the "shoulder is 
out of place." There exists, however, no 
luxation in such cases. 

If serious injury is done the nerve so 
that it undergoes degenerative changes, 
there will result atrophy of the muscles 
that derive their nerve supply from the 
suprascapular nerve. 

Treatment. — During the first few days 
following injuries which result in this 
form of paralysis, it is well to keep the subject inactive, and 
if much inflammation of the injured structures contiguous to 
the nerve exists, the application of cold packs is beneficial. 
Later, as soon as acute inflamnuition has subsided, vesication 
of a liberal area around the anteroexternal part of the scapu- 
lohumeral joint and over the course of the suprascapular nerve, 
will stimulate recovery in favorable cases. As a rule, in mild 
cases, the subject is in a condition to return to work in two or 
three weeks. 




Fig. 7 — Paralysis of the 
suprascapular nerve of 
the left shoulder. 



LAMENESS IN THE FORE LEG 77 

Radial Paralysis. 

Described under the titles of "Radial Paralysis" and "Bra- 
chial Paralysis," there is to be found in veterinary literature 
a discussion of conditions which vary in character from the 
almost insignificant form of paresis to the incurably affected con- 
ditions wherein the whole shoulder is completely paralyzed. 

When one considers the anatomy of the brachial nerve plexus 
and the distribution of its various branches, the location of this 
plexus and its proximity to the first rib, and the inevitable in- 
jury it must suffer in fracture of this bone, together with the 
inaccessibility of the plexus, it is not strange that a correct 
diagnosis of the various affections of the brachial plexus and 
the radial nerve is often impossible until several days or weeks 
have passed. And, in some instances, diagnosis is not established 
until an autopsy has been performed. Here, too, we fail to find 
cause for paralysis in some rare instances. 

Anatomy. — The radial nerve is a large branch of the brachial 
plexus and is chiefly derived from the first thoracic root of the 
plexus and is here situated posterior to the deep brachial artery. 
It is directed downward and backward ander the subscapularis 
and teres major muscles, rounding the posterior part of the 
humerus, and passing to the anterior and distal end of the 
humerus, it finally terminates in the anterior carpal region. The 
radial nerve supplies branches to the thi-ee heads of the triceps 
brachii, to the common and lateral extensors of the digit and also 
to the skin covering the forearm. 

Etiology and Occurrence. — Nothing definite is known about 
the cause of some forms of radial paralysis. However, radial 
paralysis is encountered following injury to the nerve occasioned 
by its being stretched, as in cases where the triceps brachii is 
unduly extended in restraining sulijects by means of a casting 
harness. Berns^ states that in confining horses on an old oper- 
ating table where it Avas necessary to draw the affected foot for- 
ward twenty-four to thirty-six inches in advance of its fellow. 



i"Radial Paralysis and Us Treatment by Mechanical Fixation of Knee and 
Ankle," Geo. H. Rern.s, D. V. S. Proceedings of the American Veterinary 
Medical Association, 1912, p. 219. 



78 



LAMENESS OF THE HORSE 



which was secured in a natural vertical position, radial paralysis 
of a mild form was of frequent occurrence. Country practi- 
tioners, in restraining colts hy easting with harness or ropes, 
occasionally observe a form of paresis wlierein the radial nerve 
suffers sufficient injury that there is caused a temporary loss of 
function of tlie triceps bracliii. Such cases recover witliin tliree 




Fig. 8 — Radial paralysis. 

or four days and are not a true paralysis, l)ut nevertheless con- 
stitute conditions wh<'rein normal nerve function is temporarily 
suspended. 

Symptoms. — lininediately .subsequent to injuries which in- 
volve the i-a(li;il nerve, there is manifested more or less impair- 
ment of function. Remembering the structures supplied by the 
radial nerve and its branches, one can readily understand that 
there should occur as Cadiot' has stated: 



'As f|iiotefl bv Berns, in Radial Paralysis, etc., Proceedings of the A. V 
M. A., 1912. 



LAMENESS IN THE FORE LEG 



79 



In complete paralysis, the joints of the affected limb with the 
exception of the shoulder are usually flexed when the horse is 
resting. In consequence of loss of power in the triceps and an- 
terior brachial muscles, the arm is extended and straightened on 
the shoulder, the scapulohumeral angle is open, and the elbow 
depressed. The forearm is flexed on the arm by the contraction 
of the coracoradialis (biceps brachii), while the metacarpus and 
phalanges are bent by the action of the posterior antibrachial 
muscles. The knee is carried in advance, level with, or in front 
of, a vertical line dropped from the point of the shoulder. The 
hoof is usually rested on the toe, but when advanced beyond the 
above mentioned vertical line, it may be placed fiat on the 




Fig. 9 — Merillat's method of fixing carpus in radial paraly&is. 
Alex. Eger. 



Courtesy, 



ground, the joints then being less markedly bent. When the 
limb as a whole is flexed, it may be brought into normal position 
by thrusting back the knee with sufficient force to counteract the 
action of the flexor muscles. 

When made to walk, the animal being unable to exert muscular 
action with the paralyzed structures, limply carries the member 
as a whole, and there is shortening of the anterior portion of 
the stride. There being loss of function of the triceps brachii, 
it is impossible for the subject to straighten the leg in the normal 
position for supporting weight ; therefore, any attempt to bear 



80 LAMENESS OF THE HORSE 

weight results in further flexion of tlic aftVcted mem her and the 
animal will fall if the l)Oily is not suddenly eaught up with the 
sound leg. 

Differential Diagnosis. — In making exaiuinatiun of tiiese 
eases, one can exclude fracture by absence of crepitation and 
usually, also, swelling is absent in radial paralysis. In a typical 
ease of radial paralysis, the affected leg can sustain its normal 
share of weight if placed in position, that is, if the carpal joint 
is extended in such manner that the leg is positioned as in its 
normal weight-bearing attitude. In brachial paralysis, whether 
due to fracture of the first rib or to other serious injury, it is 
impossible for the subject to support weight with the affected 
member even Avhen it is passively placed in position. 

No difficulty is ordinarily experienced in differentiating radial 
paralysis from muscular injuries to the triceps; yet, in some 
cases of "dropped elbow," it is necessary to observe the progress 
of the case for ten days or two weeks before one can positively 
establish a diagnosis. 

Quoting ]Merillat^ : "When, after four week.s. there is no 
amelioration of the paralysis, the muscles have atrophied, and 
the patient has become emaciated from ]>ain and discomfort, the 
diagnosis of brachial ]>aralysis with fracture of the first rib may 
then be announced." 

Prognosis. — When no complete paralysis of the bi*achial 
plexus or no fracture of the first rib exists, tlie majority of cases 
recover completely in from ten days to six weeks. Some writers 
claim that recoveries occur in ninety per cent of cases when 
conditions are favorable. 

Treatment. — When incomplete radial paralysis exists, little 
needs be done except to allow the subject moderate exercise and 
to provide for its comfort. Local applications, stimulative in 
character, are beneficial, and the internal administration of 
strychnin is indicated. 

In the cases where weight is not supported without the affected 
leg being passively placed in position, it is necessary to provide 
for the subject's comfort in several ways. 

Mechanical appliances such as braces of some kind in order 



'Veterinary Siirprital Operations, by L. A. Merillat, V. S., p. 507. 



LAMENESS IN THE FORE LEG 81 

to keep the affected leg iu a position of carpal extension, consti- 
tute the essential part of treatment. The leg is supported in 
such a manner that flexion of the carpus is impossible. Due re- 
gard is given to prevent chaflng or pressure necrosis by contact 
of the skin with the braces — this may be done by bandaging with 
cotton. The supportive appliance is kept in position for ten 
days or two weeks. At the end of this time the brace may be 
removed and the sul)ject given a chance to walk, and improve- 
ment, if any exists, will be evident. When there is manifested 
an amelioration of the condition, moderate daily exercise and 
massage of the affected parts are helpful. 

Should the subject be seriously inconveuienced by the applica- 
tion of a brace or other supportive appliances, it is necessary 
to employ slings. Further, if weight is supported entirely by 
the unaffected member, laminitis may supervene if a sling is not 
used. 

Thrombosis of the Brachial Artery. 

Thrombosis of the brachial artery or of its principal branches 
is of very rare occurrence in horses. 

Etiology. — Partial or complete obstruction of arteries 
(brachial or others) occurs as the result of direct injury to the 
vessel wall from compression and tension of muscles and re- 
sultant arteritis ; lodging of emboli ; and parasitic invasion of 
vessel walls causing internal arteritis. 

Symptomatology. — If sufficient collateral circulation exists to 
supply the parts with blood, no inconvenience is manifested while 
the subject is at rest. Where the lumen of the affected vessel 
is not completely occluded, there may be no manifestation of 
lameness when the ailing animal is moderately exercised. Con- 
sequently, the degree of lameness depends upon the extent of 
the obstruction to circulation ; and, likewise, the course and 
prognosis depend upon tlie character and extent of such obstruc- 
tion. 

In severe cases, lameness is markedly increased by causing 
the animal to travel at a fast pace for only a short distance. There 
are evinced symptoms of pain, muscular tremors and sudation, 
but the affected member remains dry and there is a marked dif- 



82 LAMENESS OF THE HORSE 

ference of temperature between the noi-mal areas and the cool 
anemic i)arts. AVhen the sui)ject is aHoweil to rest, circulation 
is not taxed, and there is a return to tlie orij^jinal and apparently 
normal condition, only to recur again with exertion. This con- 
dition characterizes thrombosis. 

Treatment. — In these cases, little if any good directly results 
from any sort of treatment in the way of medication. Abso- 
lute rest is thought to be helpful. Potassium iodid, alkaline 
agents such as ammonium carbonate and potassium carbonate, 
have been administered. Circulatory stimulants also have been 
given, but it is doubtful if any good has come from medication. 

Fracture of Humerus. 

The shaft of the humerus, proteetetl as it is by heavy muscles, 
is not frequently fractured; and fractures of its less protected 
parts, as for example, the head, are complicated in such manner 
that resultant arthritis soon constitutes the more serious condi- 
tion. 

As a result of falls on frozen ground, kicks or any other form 
of heavy contusion, the humerus is occasionally broken. It is 
rarely fractured otherwise. Because of the force of contusions 
usually required to effect humeral fracture, the manner in which 
the bone is broken, with respect to direction, is variable. Often 
oblique fractures exist and occasionally there occurs multiple 
fracture. In addition to the ordinarily serious nature of the 
fracture itself, there is always much injury done the adjoining 
structures. 

Symptom,atology. — Mixed lameness and manifestation of 
severe pain characterize this affection. Considerable swelling 
which increases, in some ca.ses for a week or more, is to be ob- 
served. Crepitation is readily detected, if pain and swelling is 
not too great to prevent passive movement of the member. 
Where intense pain is not manifested, because of manipulation, 
one may abduct the extremity and thereby occasion distinct 
crepitation ; but when it is possible to recognize crepitation by 
holding the hand in contact with the olecranon while the animal 
is made to walk, this method is to be preferred, if the subject 



LAMENESS IN THE FORE LEG 83 

can move without serious difficulty. The pathognomonic symp- 
tom here is recognition of crepitation, but tliis may be very diffi- 
cult to recognize in fracture of condyles, and in such instances, 
a careful examination is necessary. Gentle manipuUition in a 
manner that pain is not aggravated will tend to inspire confi- 
dence on the part of the subject and relaxation of muscles will 
enable the operator to detect crepitation. 

Course and Prognosis. — Because of the direction of the long 
axis of the humerus, with relation to the l)ony column of the 
extremity, it is obvious that any lateral movement of the leg 
tends to rotate the shaft of this bone. In fractures of the shaft 
of the humerus, then, it is apparent that immobilization is very 
difficult if at all possible. 

The proximity to the axillary lymph glands makes for easy 
dissemination of infection when the contused musculature be- 
comes infected. The adjacent brachial nerve plexus is so very 
apt to become involved, if not actually injured at the time frac- 
ture occurs, that paralysis is a probable complication. Conse- 
quently, it is logical to reason that because of the many possible 
serious complications, such as shock, occasioned by the injury 
and the distress and pain which this accident produces, recov- 
ery must be the exception in fracture of the humerus. How- 
ever, recoveries do take place and in addition to the reported 
recoveries by Liautard, IMoller, Stockfleth, Lafosse, Frohner and 
others, we have instances cited by American practitioners where 
cases resulted in recovery. Thompson^ reports a good recovery 
in a 1600-pound mare where there existed an oblique fracture 
of the humerus. This mare was kejit in slings for eight weeks. 
Walters- reports complete recovery in humeral fracture in a foal 
three days old. The only treatment given was the application 
of a pitch plaster from the top of the scapula to the radius. 
The colt was kept in a comforta])le box stall and in about four 
weeks regained use of the leg. Complete recovery eventually 
resulted. In the experience of the authoi-, recovery has not oc- 
curred in humeral fractures. 



'A paper piesented before the Illinoi.s Veterinary Medical Assn. by Dr. H. 
Thoinij.son of Paxton, III., American \'eterinary Keview. VcA. 15, p. 1.34. 

-"Fractures in Foal.s," by Dr. Wilfred Walter.s, M. R. C. V. S., American 
Journal of Veterinary Medicine, Vol. !>, p. 669. 



84 LAMENESS OF THE HORSE 

Treatment. — Wlieii animals are not aged and of sufticient 
value to justify treatment, they are best supported in a sling, if 
halter broken. If subjects are nervous, wild and unbroken, it 
is possible to emjjloy the sling, if care is given to train the ani- 
mal to this manner of restraint. The presence of an attendant 
for a day or two will reassure such subjects so that even in 
these cases it may be practica])le to employ the sling. 

Braces and other mechanical appliances intended to immobi- 
lize the parts are not of practical benefit in the horse. Unlike 
the dog, the horse as yet has not been successfully sul)jected to 
tolerating rigid braces for the shoulder and hip. 

Everything possible must be done that will make for the pa- 
tient's comfort. If the subject turns out to be a good self nurse, 
and the nature of the fracture is such that practical apposition 
of the broken ends of bone may be maintained, recovery will 
occur in some cases. 

Inflsunmation of the Elbow. 
(Arthritis.) 

Affections of this articulation other than those which are pro- 
duced by traumatism are rare. This joint has wide articular 
surfaces, and securely joined as they are by the heavy medial 
and lateral ligaments (internal and external lateral ligaments), 
luxation is practically impossible. When luxation does occur, 
irreparable injury is usually done. Castagne as quoted by 
Liautard^ reports a case of true luxation of the elbow joint in a 
horse where reduction was effected and complete recovery took 
place at the end of twenty-five days. This is an unusual case. 
The average practitioner does not meet with such instances. 

Anatomy. — The condyles of the humerus articulate with the 
glenoid cavities of the radius and a portion of the ulna. Two 
strong collateral ligaments pass from the distal end of the hu- 
merus to the head of the radius. Tlie capsular ligament is a 
large, loose membrane which encloses the articular portion of the 
humerus with the radius and ulna and also the radioulnar articu- 
lation. It is attached anteriorly to the tendon of the biceps 



'American Veterinary Review, Vol. 26, p. 1068. 



LAMENESS IN THE FORE LEG 85 

brachii (flexor brachii). The capsule extends downward be- 
neath the origin of these digital flexors. This fact should be 
remembered in dealing with puncture w^ounds in the region, lest 
an error be made in estimating their extent and an open joint 
be overlooked at the initial examination. 

Etiology and Occurrence. — Exclusive of specific or metastatic 
arthritis, which is seldom observed except in young animals, in- 
flammation of the elbow joint is usually caused by injury. This 
articulation is not subject to pathologic changes due to concus- 
sion or sprains as occasioned by ordinary service, but is fre- 
quently injured by contusion from falls, blows from the wagon- 
pole and kicks. Wounds which affect the elbow joint, then, may 
be thought of in most cases, as resultant from external violence. 
They may be contused wounds or penetrant wounds. Sharp 
shoe-calks afford a means of infliction of penetrant wounds which 
may occasion open joint and infectious arthritis. 

Classification. — A practical manner of classifying inflamma- 
tion of the elbow is on an etiological basis. Eliminating the 
forms of elbow inflammation, such as are caused by metastatic 
infection and other conditions which properly belong to the do- 
main of theory of practice, we may consider this affection under 
the classification of contusive ivounds and penetrative wounds. 

Symptomatology. — Any injury which is of sufficient violence 
to occasion inflammation of the elbow causes marked lameness 
and manifestation of pain. The degree of lameness and distress 
manifested by the subject, depends upon the nature and extent 
of the involvement. A contusion suffered as the result of a fall, 
which occasions a circumscribed inflammation of the structures 
covering this joint and where little inflammation of the articu- 
lating parts exists, marked evidence of pain and lameness might 
be absent. On the other hand, if a true arthritis is incited, there 
will be evident distress manifested, such as hurried respiration, 
accelerated pulse, inappetence, mixed lameness, local evidence 
of inflammation and particularly marked supersensitiveness of 
the affected parts. Considering these two extremes of manifested 
distress and injury, one may readily conclude that in the fre- 
quently seen case, w^herein contusion has occasioned a moderate 



86 LAMENESS OF THE HORSE 

dc^rt't' of injury, prognosis is favorable and recovery ordinarily 
follows in the course of a few weeks' treatment. 

In cases of arthritis due to penetrative wounds (])ecause of 
the important function of this joint and its large capsule, which 
when intiamed discharges synovia in a manner that closure of 
such an open joint is seldom possible) a very grave condition 
results. 

Treatment. — InHammation of the elbow, such as is frequently 
seen in general practice where horses are turned out together 
and exposed to kicks and other injuries, yields to treatment 
readily, if an open joint does not exist. 

Hot packs supported in contact with th<^ elbow and kept around 
the inflamed articulation for a few days, materially decrease pain 
and tend to reduce iuHanuuation. The subject must be kept 
quiet in a comfortable stall and, if necessary, a sling used. 
Where it is impossible for the aninuU to supi)ort nnich weight 
with the injured member the sling should be employed. 

As inflammation abates, which it does in the course of from 
one to three weeks in uncomplicated cases, the subject may be 
allowed the freedom of a comfortable box stall. Vesication of 
the parts is in order, and this may be repeated in the course of 
two weeks, if it is deemed necessary. 

Penetrative wounds resulting in open joint are not treated 
with success as a rule, and because of the handicap under which 
veterinarians labor, methods of handling such cases, where large, 
important articulations are affected, are not being rapidly im- 
proved. Prognosis is usually unfavorable, and for humane and 
economic reasons, animals so affected should be destroyed. 

Ordinary wounds of the region of the elbow are treated along 
general lines usually employed. They merit no special consid- 
eration, except that it may be mentioned that with such injuries 
concomitant contusion of the parts occasions injury that does 
not recover quickly. 

Fracture of the Ulna. 

Etiology and Occurrence. — Fractures of the ulna in the horse 
are not conniion in spite of the exposed position of the olecranon. 
This bone when broken, is usuallv fractured bv heavv blows 



LAMENESS IN THE FORE LEG 87 

and any form of ulnar fracture is serious because of its function 
and position in relation to the joint capsule. Transverse frac- 
tures do not readily unite because of the tension of the triceps 
muscles, which prevent close approximation of the broken ends 
of the bone. 

Thompson^ however, reports a case of transverse simple frac- 
ture of the ulna in a mare, the result of a kick, in which com- 
plete recovery took place. He kept the subject in a sling for 
six weeks and then allowed six months rest. 

Symptomatology. — The position assumed by a horse suffer- 
ing from a transverse fracture of the ulna, is similar to that in 
radial paralysis. Crepitation may be detected by manipulating 
the parts, and in some instances of fracture of the olecranon, 
there occurs marked displacement of the broken portions of the 
bone. Lameness is intense and the parts are swollen and super- 
sensitive. The capsular ligament of the elbow joint is usually 
involved in the injury because fracture of the ulna may directly 
extend within the capsular ligament. In such cases, there is 
synovitis, and later arthritis causes a fatal termination. 

Treatment. — The impossibility of applying a bandage in any 
way to practically immobilize these parts in fracture of the ulna, 
prevents our employing bandages and splints. Therefore, one 
can do little else than to put the patient in a sling and try to 
keep it quiet and as nearly comfortable as circumstances allow. 

Fracture of the Radius. 

Etiology and Occurrence. — From heavy bloAvs received such 
as kicks, collision with trees or in falls in runaway accidents, the 
radius is occasionally fractured. In very young foals, fracture 
of the radius, as well as of the tibia and other bones, results 
from their being trampled upon by the mother. 

Symptomatology. — Excepting in some cases of radial frac- 
ture of foals where considerable swelling has taken place, there 
is no difficulty in readily recognizing this condition. The heavy 
brachial fascia materially contril)utes to the support of the ra- 



'Fractures, by H. Thompson, Paxton, HI., American Veterinary Review, 
Vol. 15, p. 134. 



88 LAMENESS OF THE HORSE 

diiLs, aud iu cases where swelling is marked, crepitatiuu may nut 
be readily detected. In fact, a sub-periosteal fracture may exist 
for several days or a week or more and then, with subsequent 
fracture of the periosteum, crepitation and abnormal mobility 
of the member are to be recognized. In such cases, the subject 
will bear some weight upon the affected nicmber, but this causes 
much distress. In one instance the author observed a trans- 
verse fracture of the lower third of the radius which was not 
positively diagnosed until about ten days after injury was in- 
flicted. In this case, without doubt, the subject originally suf- 
fered a sub-periosteal fracture of the bone and because the animal 
was a good self nurse, the brachial fascia supported the radius 
until the periosteum gave way and the leg dangled. In this 
instance infection took place and suppuration resulted. It was 
deemed advisable to destroy this animal. 

Prognosis. — In adult animals, radial fracture constitutes a 
grave condition ; generally speaking, prognosis, in such cases, is 
unfavorable. Because of the leverage afforded by the extremity, 
immobilization of the radius is difficult. Any sort of mechanical 
appliance, which will immobilize these parts, is likely to produce 
pressure-necrosis of the soft structures so contacted. There is 
occasioned thereby much pain and the subject becomes restive, 
unmanageable and sometimes the splints are completely deranged 
because of the animal's struggles, and much additional injury 
to the leg is done. Occasionally, an otherwise favorable ease is 
thus rendered hopelessly impossible to iiandle, and the subject 
must be destroyed several days after treatment has been insti- 
tuted. 

Consequently, unless all conditions are good, and the affected 
animal a favorable subject, young, of good disposition, and the 
fracture a simple transverse one, complete recovery is not likely 
to result from any practical means of handling. 

Treatment. — IMature subjects ought to be put in slings and 
kept so restrained throughout the entire time of treatment. 
Immobilization of the broken parts of the bone is the object 
sought. This is attempted by practitioners who employ various 
methods, and each method has its advocates. 



LAMENESS IN THE FORE LEG 89 

Casts are used by some and serve very well in many cases ; but 
because of their bulk and unyielding and rigid natui'e, they are 
not well adapted to use on fractures of bones proximal to the 
carpus and tarsus. This is in reference to plaster-of-paris casts 
or those of any similar material. 

Appliances which depend on glue or other adhesive substances 
combined with leather, wood or fiber for their support, are effi- 
cacious but not comfortable. 

The use of heavy leather when the member has been suitably 
padded Avith cotton and bandages, constitutes a very good man- 
ner of reducing fracture of the radius or of the tibia. Leather 
when cut to fit both the medial and lateral sides of a leg, and 
firmly held with bandages, will form a firm support that yields 
slightly to changes of position, thus making for comfort of the 
subject. 

Such a splint or support should extend from the fetlock region 
to the elbow, but the cotton and bandages are to reach to the 
foot. When one considers that, with the supportive appliance 
placed on each side of the affected member, rigidity is accom- 
plished as much from tensile strain put upon the leather as from 
its own stiffness, it is seen that the leather need not be of the 
heaviest — sole leather is unnecessary. Because of the more com- 
fortable immobilizing appliance, the subject is less restive, and 
chances for a successful outcome are materially increased 
thereby. 

In the mature subject, six or eight weeks' time is required 
for union of the parts to occur sufficiently so that splints may 
be dispensed with. Rearrangement of the supportive apparatus, 
however, is possible and usually necessary during the first few 
weeks of treatment. By employing care in handling the parts, 
the subject will be unlikely to do itself injury at the time read- 
justment of splints is being effected. 

In foals, it is best to give them the run of a box stall with 
the mother. Being agile, they get up and lie at wull without 
doing injury to the fractured member. The splints (leather is 
preferable in these cases also) are looked after and readjusted 
as necessity demands. 

Three or four weeks time is all that is required for the average 



90 LAMENESS OF THE HORSE 

young colt to bo kept in splints when suffering from simple 
trfinsvcrsc fractui-e of the radius. 

(Nimpound fi-actures are necessai'ily inoi'c difTicult to treat 
than arc tlic simple variety, hut even in sueh cases recovery re- 
sults sometimes, and the praetitionei- is justified in attempting 
treatment after having explained the situation to his elient. 

Obli(pie t'l-actures, even when simj)le, do not completely recover. 
.Muscular and tendinous conti'action, together witli the natural 
tendency for the beveled contacting parts of the broken bone to 
pass one another in obiitiue fracture, residts in shortening of the 
leg and, if union results, a large callus usually forms. Where 
shortening of btnies occur, necessarily, permanent lameness 
follows. 

Wounds of the Anterior Brachial Region. 

Etiology and Occurrence. — Contusions and lacerations of the 
forearm ai'c of fre(|uent occurrence in horses and are troublesome 
cases to handle ; particularly is this noticeable where extensive 
laceration of the parts occurs. These injuries are caused by 
animals l)eing kicked; by striking the forearm against bars in 
jumping; and in sections of the country where barbed wire is 
used to enclose pastures, extensive lacerated wounds are met 
with when horses jump into sueh fences. 

Symptomatology. — Any wound Avhich causes inflammation 
of the structures of the anterior half of the forearm, is charac- 
terized by swingingdeg-lameness. Depending upon the nature 
and extent of the injury, manifestation varies. In cases where 
laceration has practically divided all of the substance of the 
extensor tendons, it is, of course, impossible for the subject to 
advance the leg; but where lacerated wounds involve only a part 
of the extensor apparatus of the foreleg, not so much inconveni- 
ence is evident, unless the wound is seriously infected and inflam- 
mation involves contiguous structures. Therefore, in many in- 
stances, lameness is more i)ronounced in contusions of the an- 
terior brachial region than whei-e tissues have been divided more 
or less keenly. 

In every instance diagnosis is easily established. The injury 
is quite evident, and the manner of locomotion is not in itself 



LAMENESS IN THE FORE LEG 91 

an essential feature to be considered in a discussion of symptoms. 
Where a contusion of the anterior brachial structures occurs, 
there is, in addition to lameness, swelling which is painful be- 
cause of the pressure occasioned by the heavy non-yielding bra- 
chial fascia. And where suppuration occurs, there is then an 
intensely painful condition which is not relieved until pus has 
been evacuated. Rather frequently, drainage for wound secre- 
tions is a difficult problem, and approximation of the divided 
ends of muscles is always difficult to maintain. 

Treatment. — Contused wounds of tlu? anterior l)rachial region 
are treated along usual lines; that is, attempt is made to stimu- 
late prompt resolution. Hot or cold api)lications are employed 
throughout the acute stage of the affection. Complete rest is 
provided for until all pain has subsided. Later, stimulating lini- 
ments are beneficial. 

Where no injury is done the periosteum or bone, complete 
resorption of all products of iutiammation usually occurs, though 
in many instances, this is tardy — six weeks or more are some- 
times required for recovery to take place. 

If suppuration occurs, it is necessary To provide for drainage 
as soon as it is possible to distinguish the presence of pus. Due 
regard is given the manner of establishing drainage because of 
the usual existence of sub-fascial fistulae. In these cases, one 
avoids injecting solutions of aqueous antiseptics. By gently com- 
pressing the parts, pus is caused to drain out and in e^forciner 
a moderate amount of exercise at a walk, when lameness is not 
intense, drainage is maintained. Cotton packs, moistened with 
hot antiseptic solutions, and kept around the forearm for sev- 
eral hours daily, are helpful because drainage is facilitated, 
and resolution is stimulated by the increase of blood thus at- 
tracted to the parts, and pain materially diminishes. 

In lacerated wounds of the anterior l)rachial region, after 
having controlled hemorrhage, an area aroinid the wound margin 
is freed of hair by clipping or shaving. The wound is carefully 
examined, and the best site for drainage is selected and a suit- 
able opening for wound discharge is provided for. Where the 
extensor carpiradialis (metacarju maginis) with other struc- 
tures, is divided and the distal portion is torn downward, as 



92 LAMENESS OF THE HORSE 

frequently is the case in l)arbe(l wire cuts, it is necessary lo 
make careful provision for drainage. The wound is thoi-<)U<r!ily 
cleansed by means of ablutions if necessarj'; but preferably by 
swabbing with pledgets of cotton or gauze which are moistened 
in antiseptic solutions. All shreds of macerated tissue are 
clipped with sci.ssors and finally the whole wound surface is 
painted with tincture of iodin. 

If drainage is made by cutting tlirongli tlie tissues in the 
median portion of the structures that have been displaced, the 
opening should be packed with gauze so that it may remain 
patent after swelling has occurred. Such packing is left in 
situ for twenty-four hours. 

The pendant muscular portions of tissues are sutured up by 
means of tapes and, while perfect apposition is not ordinarily 
possible, it is very essential to train the pendant tissues in their 
normal position even if they require resuturing within a week. 
This minimizes graiuilation of tissue, antl there results less scar 
if the detached portions are kept near, even if not in contact with 
the proximal wound margins. The skin together with sub- 
cutaneous fascia is sutured on either side uidess drainage is to 
be provided for on one side, and the lowermost part of that side 
is left unsutured. 

After-care. — AVhere extensive suturing of tissues has been 
necessary, subjects nuist be kept quiet. They are best confined 
in box stalls and not taken out for several weeks. Particularly 
is this true where transverse division of extensors has taken place. 
Sutures are removed at the end of from ten days to three weeks 
as cases permit. Drainage of Avound secretions, which usually 
become infected, is necessary, because with obstructed drainage 
in an infected wound of this kind, there will result an early 
destruction of tissue at some point sutured. Daily irrigation 
done in a manner that practical asepsis is carried out, is neces- 
sary for about a week. All irrigation is done by way of the 
drainage opening, and this with wni-m a<iueous solutions of suit- 
able antiseptics. After a week or ten days' tim(\ the wound 
should not be dres.sed more frequently than twice weekly. 

If it is necessary to leave a portion of the wound uncovered, 



LAMENESS IN THE FORE LEG 93 

as in eases where skin is destroyed, the frequent (three or four 
daily) application of a suitable antiseptic powder is necessary 
to check exuberant granulation. This may be directly effected 
by the use of an astringent or desiccant preparation, and such 
dressing serves as a mechanical protection as well. 

When such wounds are kept clean, Avhere drainage is properly 
maintained, and the subject kept quiet, no particular attention 
other than the local application of an astringent lotion (such 
as the zinc and lead lotion) is necessary after the first three or 
four weeks. Usually, if the animal gnaws at the parts or other- 
wise manifests evidence of discomfort, it is an indication that 
new areas of infection are being established because of obstructed 
drainage or retained eschars. A thorough cleansing of the 
wound with a two per cent solution of Liquor Cresolis Com- 
positus and this followed by moistening every part of the wound 
with tincture of iodin, will check all such disturbance if done 
promptly. 

Where practically all of the anterior surface of the radius 
has been denuded, recovery is tardy and there is in some cases 
imperfect extension of the leg for months after the wound has 
healed. But in such instances, animals gradually regain com- 
plete use of the affected member and in the course of a year 
function is fully restored. 

Inflammation and Contraction of the Carpal Flexors. 

Anatomy. — The structures which are usually considered as 
true flexors of the carpus are a group of three muscles, which 
have separate heads of origin and different points of tendinous 
insertion. 

The flexor carpiradialis (flexor metacarpi internus) originates 
from the medial epicondjde of the humerus. It is inserted to 
the proximal end of the medial metacarpal (inner metacarpal or 
splint) bone. This muscle is the smaller of the three and is not 
usually divided in doing carpal tenotomy. 

Tlie flexor carpiulnaris (flexor metacarpi medius) lias two 
heads of origin ; one, the larger, originates from the epicondyle 
of the humerus and the other from the posterior surface of the 



94 LAMENESS OF THE HORSE 

olecranon. The two heads unite at the upjier third of the radius 
and the muscle, becoming tendinous, as is the case with the other 
carpal tlexors, is attached by one point of insertion to the acces- 
sory carpal bone (trapezum). The other blends with the 
posterior annular ligament of the carpus. 

The ulnaria lateralis (flexor metacarpi externus) has its origin 
from the lateral epicondyle of the humerus and inserts to the 
proximal extremity of the fourth metacarpal (outer splint) 
bone and l)y another attaelunent to the aecesvsory carpal bone 
(trapezium) with the tendon of the flexor carpiulnaris (flexor 
metacarpi medius). 

Acting together, these nniseles flex the cari>us or extend the 
elbow and this action is antagonized by the biceps l)rachii (flexor 
brachii) and extensors of the carpus and phalanges. 

Etiology and Occurrence. — Inflannnation of the muscular or 
tendinous i)arts of the carpal flexors, does not occur as fre- 
quently as does inflannnaticn of the flexors of the extremity. 
They are suliject to injury such as is occasioned by hard work 
and concussion and contract as a result ; but, more frequently 
a congenital malformation of the leg is responsible for undue 
strain upon these parts. Horses that are "knee sprung" or that 
have a congenital condition where in the anterior line, as formed 
by the radius, carpal and metacarpal bones, is bent forward at 
the carpus, are subject to inflammation and contraction of the 
carpal flexors. When these flexors are contracted, the condition 
is conunonly known among horsemen as "buck knee." In itself, 
infiaiiimation of the carpal flexors is not a condition which is 
likely to prove troublesome, l)ut because of carpal involvement 
(whieh is often present) the cause of the trouble remains, and 
inflannnation of the carpal flexors recui-s or becomes elironic 
and contraction of tendons results. 

Symptomatology.— Inflamnuition of tlie car|)al flexors, when 
acute and uncomi)]ieated, is ehai-aeterized by a painfully swollen 
condition of the affected tendons. No weiglit is ])orne upon 
the affected leg and tlie carjjjd joint is flexed. ^Hxed lameness 
is i)i-esent. There is no difficulty encountered in arriving at a 
diagnosis liecause of the very noticeably inflamed j)arts. 



LAMENESS IN THE FORE LEG 



Many fully developed cases of contraction of the tendons of 
the carpal flexors are observed where the condition has l)ecome 
established gradually and no lameness lias resulted from tendin- 
itis or carpitis. In some of these cases, subjects are stumblers 
and when they are carelessly handled or kept at fast work over 
irregular or hard roads, chronic carpitis with hyperplasia of the 
structures of the anterior carpal region results, owing to frequent 
bruising from falls. 




Fig. 10 — Contraction of carpal flexors, "knee spruuj;." 

Where inflammation is caused by a puncture wound and sub- 
fascial infection occurs, there is evident manifestation of pain. 
No weight is supported by the affected member and because of 
the pressure, occasioned by the swollen muscles confined within 
the non-yielding brachial fascia, there exists marked supersensi- 
tiveness of the affected parts. Flexion of the elbow is avoided 
because contraction of the biceps brachii (flexor brachii) or the 
extensors, which are antagonists of the flexors of the carpus, 
tenses the carpal ficxoi-s and pain is thereby increased. 

However, in most instances, the practitioner's attention is not 
directed to typical and uncomplicated cases, but to subacute or 
chronic inflammations which are often attended with contraction 
of the tendinous pai'ts of the carpal flexors, and in such cases 



96 LAMENESS OF THE HORSE 

carpitis is present. Animals so affected have lost the rigidity 
which characterizes the normal carpal joint when the leg is a 
weight bearing meml)er, and because of its sprung condition, 
the leg trembles when supporting weight. 

Treatment. — Acute inflammation is treated by means of local 
application of cold or hot packs until the pain and acute stage 
of inflammation has subsided and later stimulating liniments 
are indicated. Absolute quiet must be enforced. Especially 
where the carpus is involved must the subject be kept quiet until 
all evidence of inflammation has subsided. 

The application of vesicants or line-firing is beneficial in sub- 
acute inflammation of the tendons of the carpal flexors. "Where 
contraction of tendons exists and no osseous or ligamentous 
change prevents correction of the condition, tenotomy is neces- 
sary. The reader is referred to Merillat's "Veterinary Surgery"^ 
for a good description of the technic of this operation. 

In all serious cases of inflammation of the carpal flexors, 
whether tenotomy has been performed or not, the subject needs 
a long period of rest subsequent to treatment. In fact, three 
or four months at pasture is necassary to permit of recovery 
and this where no congenital deformity has predisposed the sub- 
ject to such affection of the flexors. Return to work must be 
gradual and the character of the work such as to enable the 
animal to become inured to service w'ithout a recurrence of the 
trouble if possible. 

It follows then, that tenotomy, here as in other cases, is not 
practical from an economic viewpoint, unless the animal be of 
sufficient value to justify the long period of rest for recovery. 
Tenotomy is not of practical l)enefit unless ample time is allowed 
for regeneration of divided tendinous tissue. 

Fracture and Luxation of the Carpal Bones. 

Etiology and Occurrence. — Fracture of the carpal bones is of 
inrrequent occiirn'iK'e in horses and, wlien it does occur, it is 
usually due to injuries, and because of their nature (resulting 
as they generally do from heavy falls or in l)eing run over by 



^Veterinary Surgical Operations, by L. A. Merillat, Vol. 3, p. 19S. 



LAMENESS IN THE FORE LEG 97 

street cars or wagons), a comminuted fracture of one or more 
bones exists. The accessory carpal bone (trapezium) is said to 
be fractured at times without being subjected to blows or like 
injuries, but this is exceptional. 

Luxations of the carpal joint are of rare occurrence, and very 
few cases of this kind are on record. AValters^ reports a case 
of carpometacarpal luxation in a pony wherein reduction was 
spontaneous and an uneventful recovery followed. His reason 
for reporting the case, as he states, is its rarity. 

Symptomatology. — Fractures of the carpal bones as they 
usually take place are diagnosed without difficulty. Because 
of their usually being comminuted, abnormal movement of the 
joint is possible. Such movement is not restricted and flexion 
of the leg at the carpus in any direction is possible. Crepitation 
is readily detected and frequently these fractures are of the 
compound-comminuted variety. 

In fracture of the accessory carpal bone (trapezium) or in 
fracture of any other single bone when such exists, there is no 
increase in the movement of the joint. The accessory carpal 
bone may be readily manipulated and when fractured, its parts 
are more or less displaced. Recognition of fracture of any other 
single carpal bone must be done by detecting crepitation unless 
it be a compound fracture, whereupon probing is of aid in es- 
tablishing a diagnosis. 

Carpal luxation when present is to be recognized by finding 
the apposing carpal bones joined in an abnormal manner — that 
is, out of position. There is restricted or suspended function 
of the joint, and in the eases recorded, no difficulty has been 
experienced in making a diagnosis. The carpometacarpal por- 
tion of the articulation is the part which is usually affected. 

Prognosis and Treatment. — There is no chance for complete 
recovery in the usual case of carpal fracture because of the fact 
that there results sufficient arthritis to destroy articular cartilage 
beyond repair. In the average instance, because of arthritis 
which persists for a considerable lengtli of time, more or less 
ankylosis results. At best, one can only hope for partial re- 



iWilfred Walters, American Journal of Veterinary Medicine, Vol. 8, p. 606. 



98 LAMENESS OF THE HORSE 

covery, that is to say, the member may regain its usefulness as 
a weight-supporting part, but because of restricted or abolished 
joint function, locomotion is more or less difficult. Exostoses, 
articular and periarticular, occur and the carpus usually be- 
comes a large immobile articulation. There is danger of infec- 
tion resulting in simple carpal fractures and, needless to say, 
in a compound-comminuted fracture of the carpus, infection 
usually occurs and a fatal outcome is probable. 

When treatment is instituted, antiseptic precautions are taken 
in handling the compound fractures, and in any case immobiliza- 
tion of the parts is sought. Here, as has been previously pointed 
out, it is best to employ leather splints, so that a maximum de- 
gree of rigidity with a minimum of distress and inconvenience 
to the patient will result. The leg must be bandaged from the 
hoof upward, making use of a sufficient amount of cotton to 
ensure against pressure-necrosis. The leather splints are placed 
mesially and laterally and, of course, need to extend as high 
as the proximal end of the radius. Subjects must he kept in 
slings until union of bones has become established, and as a 
rule there will then exist marked ankylosis. 

There is no particular difference in the handling of carpal 
luxation and dislocation of other bones. Where ligaments have 
not been destroyed to the extent that reduction is of no prac- 
tical use, the parts are kept immobilized, if thought necessary. 
Later, vesication of the whole pericarpal region is done and the 
subject allowed exercise at will. 

Carpitis. 

Etiology and Occurrence. — Inflammation of the carpus is 
caused by contusions, such as are occasioned in falling, by kicks 
by striking the carpus against objects in jumping and some- 
times by striking it against the manger in pawing. The con- 
dition is of rather frequent occurrence. 

Symptomatology. — Evident symptoms of inflammation in 
carpitis are always present — hyperthermia, supersensitiveness 
and swelling. Also, there exists lameness which is characterized 
by an apparent inability to flex the leg. and there is circum- 



LAMENESS IN THE FORE LEG 



99 



duction of the leg as it is advanced because in this way little if 
any flexion of the carpus (which increases pain) is necessary. 

Depending upon the nature of the cause, there occurs a 
marked difference in the character and amount of swelling. 




Fig. 11 — Pericarpal inflammation and enlargement due to injury. 

Naturally, when much extravasation of serum and hlood takes 
place, there is occasioned a fluctuating swelling which is usually 
less painful to the subject upon manipulation than is a dense 
inflammatory change without marked extravasation. 

In acute carpitis, there is present, then, a very painful con- 
dition which involves the articulation, causing marked lameness, 
disturbance of aiii)etite and some elevation of temperature. 

Chronic cases do not occasion serious pain or constitutional 
disturl)ances, but do interfere with locomotion in direct propor- 
ti(m to the existing articular inflammation and periarticular 
hypertrophy of ligamentous and tendinor.s structures. 

Treatment. — If possible, keep the subject absolutely quiet, 
employing the sling if necessary. Dui-ing the first sta^^es of in- 
flammation, the application of ice packs to the affected parts, is 



100 



LAMENESS OF THE HORSE 



of marked benefit. At the end of forty-eight hours, hot applica- 
tions may be used and this treatment continued throughout sev- 
eral days. Anodyne liniments are of service and should be em- 
ployed throughout the acute stage of intiammation during in- 
tervals between the hydrotherapeutic treatments. 

As inflammation subsides, a counterirritating application such 




Fig-. 12 — Hygromatous condition of the right carpus, also distension of 
sheaths of extensor tendons of both fore legs. 

as a suitable liniment and later blistering or line-firing is help- 
ful in stimulating resolution. 



Open Carpal Joint. 

Anatomy. — The carpal bones as they articulate with one an- 
other and with the radius and metacarpal bones, as classed by 
anatomists, form three distinct articular parts of the joint as a 
whole and are known as radiocarpal, intercarpal and carpometa- 
carpal. These three pairs of articulating surfaces are all en- 
closed within one capsular ligament. On the anterior face of the 
bones, the capsular ligament is attached to the carpal bones in 



LAMENESS IN THE FORE LEG 



101 



such manner that an imperfect partitioning of the three joint 
compartments is formed. Posteriorly, the capsule is very heavy 
and forms a sort of padding over the irregular surfaces of the 
bones, and also its reflexions constitute the sheaths of the flexor 
tendons. The anterior portion of the capsular ligament forms 
sheaths for the extensor tendons, and both portions of the joint 
have an attachment around the distal end of the radius and 
another at the proximal end of the metacarpal bones. 

Etiology and Occurrence.— Puncture wounds of any kind 




Fig 



Carpal exostosis in aged horse. 



may serve to perforate the joint capsule and such traumatisms 
are occasioned by falls, kicks and in various ways in runaway 
accidents, and open carpal joint may follow. 

Symptomatology. — The pathognomonic symptoms of the ex- 
istence of an open joint is the exposure to view of articular 
surfaces of bones or noting the escape of synovia from the joint 
capsule. As has been previously referred to, there always exists 
a peculiar suspension of carpal flexion in all cases of carpitis. 

Non-infective wounds which may cause open joint are not 
necessarily productive of an active carpitis — a synovitis may 
be the extent of the disturbance. Unlike synovitis, which may 



102 



LAMENESS OP THE HORSE 



characterize a non-infectious penetrative wound of the capsular 
ligament, septic arthritis which may supervene is a very painful 
intiammatory disturbance. It is characterized by all of the 
symptoms which attend the case of open joint and synovitis plus 
the obvious manifestation of great pain. There is an elevation 
of temperature of from two to five degrees above normal ; cir- 
culation is accelerated; the pulse is bounding; respiration is 
hurried; there is an expression of pain as indicated by the 
physiognomy ; and because of rapid erosive changes of cartilages 
which take place, there is soon so much of the articulation de- 
stroyed that death is inevitable. Death is usually due to gen- 
eralization of the arthritic infection. 

In the meanwhile, if the character of the infectious material 
is not so virulent, the disease will take on a slower course 

and the subject may experience 
laminitis from supporting weight 
upon the sound member, or be- 
cause of continued recumbency, 
decubital gangrene and emacia- 





Fig. 14 — Exostosis of carpus 
resultant from carpitis. 



Fig. 15 — Distal end of radius. U- 
lustrating the effects of chronic car- 
pitis. 



LAMENESS IN THE FORE LEG 103 

tion sometimes cause death. If the subject does not soon suc- 
cumb, it is compeDed to undergo days or even weeks of unneces- 
sary suffering, and too often in such cases, it is later deemed 
advisable to destroy the animal because of the cost of continuing 
treatment until the horse is servicea])le. Therefore, it is evident 
that when such joints as the carpus or tarsus are open and infec- 
tion exists, if they are not promptly treated and the infectious 
process checked, it is neither humane nor practical to prolong 
treatment. 

Distinction must be made between the different joints wher. 
infected as the condition is much more serious in some cases 
than in others. All things considered, perhaps open joints rank, 
with respect to being serious cases as follows: elbow, navicular, 
stifle, tarsus, carpus, fetlock and pastern. This, of course, is 
restricted to articulations of the locomotory apparatus. 

Treatment. — Preliminary care in the treatment of an open 
carpal joint, is the same as has been described in this condition 
as it affects the scapulohumeral articulation described on page 
65. Likewise the further treatment of such cases is along the 
same lines except that where it is possible, the parts are kept cov- 
ered with cotton and bandages. However, in some cases, animals 
have been successfully treated without bandaging and by keep- 
ing the patient in a standing position and on pillar reins until 
recovery resulted. Such cases were of the non-infectious type 
and recovery was possible within three or four weeks. Further, 
the condition is not sufficiently painful in such instances as to 
prevent the subjects bearing weight with the affected member; 
hence, no danger of resulting laminitis is incurred. And finally, 
where bandages are not employed, the frequent use of antiseptic 
dusting powders is substituted for cotton as a protector. 

When bandaged, such wounds need dressing more or less fre- 
f|Uontly, as individual instances demand. The purulent infective 
inflannnation of a carpal joint will rcMpiire daily dressing; where- 
as, in other cases (non-infective), semi-weeklj^ change of band- 
ages is sufficient. Efjual i)arts of ])oric acid and exsiccated alum 
constitute a suitable combiiuition for the treatment of these 
cases, and this powder should ))(> liberally employed. Tincture 
of iodin may be injected into the joint capsule where there is 



104 LAMENESS OF THE HORSE 

provision for its ready evacuation, as conditions seem to require. 
Daily injections for three, four or five days, are not harmful 
and will control infection in many instances. 

Thecitis and Bursitis. 

Etiology and Occurrence. — The thecae and bursae of the leg 
are several in number. In the carpal region, the flexors of the 
phalanges are contained together in the carpal sheath, and this 
is the principal theca in the carpal region. Each of the tendons 
is provided with synovial sheaths which are subject to inflam- 
mation and occasionally synovitis and distension of these synovial 
sheaths occur. 

Because of faulty conformation, some animals are subject to 
inflammation of these sheaths, and all forms of strenuous work 
which taxes the tendons greatly is apt to result in synovitis. 
Direct injury such as blows may be the cause of synovial disten- 
sion of thecae and the affection is to be seen in all horses that 
have done much fast work on hard road surfaces or pavements. 

The usual case as it occurs in practice is a non-infective syn- 
ovitis, but where puncture wounds cause the trouble, an in- 
fectious inflammation obtains. 

Symptomatology. — No trouble is experienced in diagnosing 
distension of tendon sheaths, for the affection is very palpable. 
During acute inflammatory stages of this affection, some lame- 
ness is present — in infectious inflammation lameness is intense. 
Local heat and pain upon manipulation are readily discernible 
in all acute cases. And finally, where there is reason for doubt, 
an aseptic exploratory puncture of the wall of the fluctuating 
enlargement may be made with a suitable trocar, and the dis- 
charging synovia will be proof of the existence of synovial dis- 
tension. 

After the affection becomes subacute or chronic, no lameness 
or inconvenience is manifested, and the condition is undesirable 
only because of its being a blemish. 

Treatment. — Acute non-infectious synovial distension of ten- 
don sheaths is treated by aspirating as much synovia as pos- 
sible from the affected theca (this is, of course, done under 



LAMENESS IN THE FORE LEG 105 

strict asepsis) and by means of bandages, a uniform degree of 
pressure is kept over the parts for ten days or two weeks. The 
patient is kept quiet and in the course of two weeks an active 
blistering agent is employed over the region affected. Usually, 
at the end of a month's time, complete recovery has taken place 
and the subject may be gradually returned to work. 

When synovial distensions are of long standing, it is necessary 
to take special precautions to check excessive secretion of synovial 
fluid, and, also because of the atonic condition of the tissues 
affected, resolution is tardy. In addition to aspirating synovia, 
the introduction of equal parts of alcohol and tincture of iodin 
into the theca is necessary. The quantity of this combination 
injected, depends upon the size of the sheath affected and the 
amount of synovia retained at the time injection is made. Ex- 
perience is necessary to judge as to this part of the work, but 
one may consider that a quantity between three and ten cubic 
centimeters of equal parts of tincture of iodin and alcohol con- 
stitutes the proper amount to employ. Where much synovia is 
contained within the sheath at the time of injection, there occurs 
great dilution of the agent injected and consequently less irri- 
tation results. 

The object of such injections is to check synovial secretion, 
and this is sought by the local effect of iodin in contact with the 
secreting cells together with the reactionary swelling which oc- 
casions pressure. An increase in the local blood supply also 
follows. In all cases where it is possible to employ suitable 
bandages, this should be done. The ordinary derby bandages 
serve well and if their use is continued for a sufficient length of 
time, good results follow. 

There are other methods of treating these affections, and each 
has its advantages and disadvantages. Line-firing, instead of 
the vesicant is made use of by some, but the object desired is 
the same and results obtained are similar. 

Sheaths may be opened surgically by means of a knife, and 
the removal of a portion of the wall of distended and atonic 
tendon sheaths is possible. These operations belong to the realm 
of surgery and are not properly a part of this treatise. However, 
in pa.ssing, it may be said that if a perfect technic is possible in 



106 LAMENESS OF THE HORSE 

doing the last named operation, a permanent recovery is the 
outcome. 

Fracture of the Metacarpus. 

Etiology and Occurrence. — As the result of all sorts of vio- 
lence, such as falls and injuries in accidents of various kiuds 
wherein the metacarpals are subjected to contusions, fractures 
may result. In the horse it is unusual for fracture of one of the 
small metacarpal bones to take place without there being at the 
sam.e time a fracture of the third (large) metacarpal bone. 

Classification. — Fractures of the metacarpal bones as they 
occur, are as likely to be compound as simple, and the multiple 
and comminuted varieties are occasionally observed. The man- 
ner in which the third (large) metacarpus is fractured, largely 
determines the outcome in any given case. 

Symptomatology. — Abnormal mobility of the broken parts 
of bone and crepitation mark fracture of the metacarpus, and 
the condition is easily diagTiosed. In many instances, when 
compound fracture exists, broken ends of bone are protruding 
through the skin. No weight is borne upon the fractured mem- 
ber ordinarily, although during the excitement occasioned by 
runaways, horses are sometimes seen to support weight with a 
broken leg even when the protruding bone is sunk into the 
ground in so doing. 

Prognosis. — Generally speaking, fractures other than the 
simple-transverse in young animals, are considered unfavorable 
cases. AVith the metacarpus, however, there are instances where 
compound fracture occurs in colts that justify treatment. But 
in all cases of compound fracture, the element of infection in 
addition to the increased difficulty in maintaining immobility 
of the broken bone, creates almost insuperable difficulties in the 
average instance. And unless the practitioner distinctly ex- 
plains to his client the various reasons which make treatment an 
economic impracticability, dissatisfaction is likely to follow if 
treatment is instituted without such an understanding. 

Treatment. — Perfect apposition of the broken ends of l)one 
is easily effected and less difficulty is encountered in maintain- 



LAMENESS IN THE FORE LEG 107 

ing such relations in metacarpal fractures than in fractures of 
the radius. However, reduction and immobilization of this as 
in all fractures, must be done without delay. In simple fracture, 
the metacarpus is covered with enough cotton to pad the parts, 
and this is retained in position by liandages. Splints of heavy 
leather or of thin pieces of tough flexil)le wood are placed on 
each side of the leg and firmly held in position with bandages. 
Bandages may be put on in layers and a coating of glue ap- 
plied over each layer if this is thought necessary. The ad- 
vantage gained in using glue or other adhesive materials is that 
the cast thus formed is more rigid than where such material is 
not employed. On the other hand, all elasticity is lost as soon 
as the cast adapts itself to the contour of the extremity, and 
because of this rigidity, it is doubtful if anything is gained by 
the incorporation of glue, except in the way of added strength of 
the cast. Since the animal does not walk upon the broken leg, 
it is possible to employ splints of suitable materials which are 
retained in position without glue and frequent readjustment of 
a part of the immobilizing apparatus is possible. This is im- 
possible with casts. 

In compound fractures, provision ought to be made for dress- 
ing the wound of the soft structures. This entails adjusting 
the splints in such manner that one splint may be retained and 
others removed for dressing the wound and readjusted as often 
as wound dressing is necessary. 

Splints. 

By this term is meant a condition where there exists an 
exostosis which involves usually the second (inner small) and 
third (large) metacarpal bones. While an exostosis involving 
any one of the splint bones, even wben dii'cctly caused by an 
injury, is called a "si)lint, " the term is employed hei'c, in refer- 
ence to exostoses not duo to dii-ect injury such as in contusions. 

Etiology and Occurrence. — This condition is one wherein 
there is osseous formation following a jxM-iostitis and the region 
of the upper portion of the second (inner small) metacari>al bone 
is the usual site of the exostosis. There is incited an intiamma- 



108 LAMENESS OF THE HORSE 

tion of the periosteum at the site of the interosseous ligament 
which attaches the small to the large metacarpal bone. This liga- 
ment is involved in the inflammatory process, and according to 
Havemann, whose view is supported by Moller, this inflamma- 
tion is the origin of the trouble. 

Various theories attempting an explanation of the frequent 
affection of this one certain part so regularly involved have been 
offered, but no proof of the correctness of any exists. It fol- 
lows, however, that splints occur in young animals; that the 
affection seldom starts in subjects that are ten years of age or 



-fi>< 




Fig. 16 — Posterior view of radius (right) illustrative of effects of splint. 
Note the extent of exostosis. 

older, and that when the exostosis has formed, lameness usually 
subsides. Anything which will cause undue strain or irritation 
of the metacarpal bones in young animals, is quite apt to result 
in a splint being formed. Concussion siieh as is caused by fast 
work on hard roads, or work on rough or irregular road surfaces 
which cause unequal distribution of weight, will cause splint 
lameness and exostosis follows. 

Course. — Because of the peculiar manner in which the second 
and third metacarpal bones articulate in young animals, until 
the bones become ossified and permanently joined, the inflam- 
mation which attends the acute stage of this affection, causes 
lameness. Later, unless an unusually large exostosis is formed, 
which may cause a constant irritation due to its size and juxta- 
position to the carpus, lameness is discontinued. 



LAMENESS IN THE FORE LEG 109 

Symptomatology. — Lameness is usually the first manifesta- 
tion of this disorder, and the thing which characterizes splint 
lameness is its peculiar interniittence. There is a mixed form of 
lameness which may not be in evidence when an affected animal 
is started on a drive, ])ut which is marked after the subject has 
gone some distance. The animal may, however, go lame through- 
out the whole of a drive and continue to be lame for several 
days or weeks in some cases. It is noticeable that lameness is 
augmented or produced when the subject travels on rough road 
surfaces and that little or no difficulty is encountered when roads 
are smooth. 

The heavy brachial fascia is inserted in part to the head of 
the second metacarpal (inner small) bone together with the 
oblique digital extensor (extensor metacarpi obliquus) and this 
explains the reason for pain lieing manifested during extension 
of the member. 

Before there is a visible exostosis, supersensitiveness is readilj^ 
recognized upon palpation of the parts, if careful comparison is 
made between the sound and unsound members. However, fre- 
quently splints occur on both forelegs at the same time and in 
some instances exostoses are several in number upon each mem- 
ber affected. In some instances, the affection involves the outer 
splint bone and no evident involvement of the inner one exists. 

Treatment. — At the onset complete rest should be provided 
and the local application of some good cataplasm is in order. A 
stimidating liniment is beneficial when employed several times 
daily and massage is also quite helpful. Later, the ap])lication 
of a blistering ointment is good treatment. The use of the actual 
cautery stimulates prompt resolution, l)ut there is seldom any 
resorption of products of infiammation following firing. AVhere- 
as, in cases Avhere other treatment is l)egun early, there usually 
follows consideralile diminution in the size of the exostosis. A 
rest of four or five weeks is necessary and very young animals 
should not be put to work too soon, if the character of the work 
is such as to induce a recurrence of the trouble. 

Many cases are treated successfully in draft types of animals 
(where the subjects are not kept at work that occasions seri- 



110 LAMENESS OF THE HORSE 

Oils irritation to the affected parts) by blistering the exostosis 
repeatedly and allowing the animals to continue in service. In 
such cases, it is unreasonable to expect to check the size of the 
exostosis and, of course, such methods are not employed where 
lameness causes distress to the subject. 

Firing usually causes prompt recovery from lameness and is 
a dependable manner of treating such cases but there remains 
more blemish following cauterization than where vesication is 
done. 

OPEN FETLOCK JOINT. 

This condition, because of the frequency with which it occurs 
may be taken as typal, from the standpoint of treatment and 
results obtained therefrom. While it serves to constitute a basis 
from which other joints, when open, are to be considered, due 
allowance must be made for the fact that, as has been previously 
mentioned, some articulations when open constitute cause for 
grave consequences ; while with others an open capsule, even 
when infected, does not cause disturbance enough to be classed 
as difficult to handle. Moreover, the fetlock joint is admirably 
suited, anatomically, to bandaging ; and when w^ounded, is easily 
kept protected by means of surgical dressings. This fact is of 
great importance in influencing the course and termination in 
any given case of open fetlock joint and should not be forgotten. 

There is no logical reason for comparing the pedal joint wath 
the pastern on the basis that it may also be completely and se- 
curely bandaged. Open navicular joint does not occur, as a 
rule, except by way of the solar surface of the foot, and the in- 
troduction of active and virulent contagium is certain to happen ; 
consequently, an acute synovitis quickly resulting in an intensely 
septic and progressively destructive arthritis soon follows in 
perforation of the capsule of the distal interphalangeal articula- 
tion. 

Etiology and Occurrence. — AVounds of the fetlock region re- 
sulting in perforation or destruction of a part of the capsular 
ligament are caused by all sorts of accidents, such as wire cuts, 
incised wounds occasioned by plowshares, disc harrows, stalk 
cutters and other farming implements. In runaways the joint 



LAMENESS IN THE FORE LEG 111 

capsule is sometimes punctured by sharp pieces of wood or other 
objects. In liorses driven on un paved country roads the fetlock 
is occasionally wounded by being struck against the sharp end 
of some ol)ject, the other end of which is firmly embedded in the 
ground. In one instance the author treated a case wherein the 
fetlock joint was perforated by the sickle-guard of a self-binder. 
In this case there occurred complete perforation causing two 
openings through the cnl-de-sac of the joint. Such wounds are 
produced by implements which are, to say the least, non-sterile, 
and this perforation of the uneleansed skin conveys infectious 
juaterial into the joint capsule. Yet in many instances, espe- 
cially in country practice, no infectious arthritis results where 
cases are promptly cared for. 

Symptomatology.— A difference in the character of symp- 
toms is evidenced when dissimilar causes exist. Small penetrant 
wounds which infect the synovial membranes cause infectious 
arthritis in some cases, whereas a wound of sufficient size to 
produce evacuation of all synovia will, in many instances, cause 
no serious distress to the subject, even when not treated for sev- 
eral days. If it is not evident that an open joint exists and the 
articular cavity is not exposed to view a positive diagnosis may 
be early established by carefully pro))ing the wound^ In some 
cases where a small wound has perforated the joint capsule, 
swelling and slight change of relation of the overlying tissues 
may preclude all successful exploratory probing. In such in- 
stances it is necessary to await development of symptoms. 
Twenty-four hours after injury has been inflicted, there is notiee- 
al)le discharge of synovia which coagulates about the margin of 
the orifice, where synovial discharge is possible. Particularly 
evident is this accumulation of coagulated synovia where wounds 
have been bandaged— there is no mistaking the characteristic 
straw-colored coagulum which, in such cases, is somewhat ten- 
acious. 

No difference exists between other symptoms in iiifectious 
arthritis caused by punctures, and non-infectious arthritis, ex- 
cepting the intensity of the pain occasioned, the rise in tempera- 
ture, circulatory disturbances, etc. ; all of which have been pre- 
viously mentioned. 



112 LAMENESS OF THE HORSE 

Treatment. — Just as has been stated in discussions on the 
subject of open joint, probing or other instrumentation is to be 
avoided until the exterior of the wound and a liberal area sur- 
rounding has been thoroughly cleansed — too much importance 
can not be placed on this preliminary measure. In cases of open 
joint where ragged wound margins exist and the interior of the 
joint capsule is contaminated, much time is required to 
thoroughly cleanse all soiled parts. In some instances an hour's 
time is required for this cleansing process after the subject has 
been restrained and prepared. In order to thoroughly cleanse 
these delicate structures without doing them serious injury, one 
ought to be skillful and careful in all manipulations of the ex- 
posed parts of the joint capsule. 

The general plan of treatment, after preliminary cleansing 
has been accomplished, has been outlined on page 66 in the 
consideration of scapulohumeral joint affections. The injection 
of undiluted tincture of iodin in ounce quantities, it must be 
remembered, is not to be done unless there is provision for its 
free exit. Where good drainage from the joint cavity exists 
all infected wounds should be thus treated, and this treatment 
may be repeated as conditions seem to require — until infection 
is checked. 

If daily injections are necessary, dilution of the tincture of 
iodin with an equal amount of alcohol is advisable in order to 
avoid doing irreparable damage to the articular cartilages and 
synovial membranes. 

An antiseptic powder composed of equal parts of boric acid 
and exsiccated alum is employed to protect the wound surfaces 
and the margins, and the parts are then bandaged. In bandag- 
ing wounds of this kind a liberal amount of cotton should be 
employed, and after a large surface surrounding the wound has 
been thoroughly cleansed, it must be so kept thereafter. This 
is impossible, if one uses a small amount of cotton, particularly 
if such meager quantity of dressing material is carelessly 
wrapped in position with an insufficient amount of bandage ma- 
terial. ]\Iention, without description of the elemental problem 
of applying cotton and bandages to a wound, would be suffi- 
cient, were it not that this is a very important part of the hand- 



LAMENESS IN THE FORE LEG 113 

ling of such cases, and many practitioners are not only thought- 
less in this part of their work, but also apparently careless. 
What does it profit to prepare a part and cleanse a wound with 
painstaking care and then neglect to take every possible precau- 
tion to prevent its subsetiuent contamination? 

In the handling of open joint capsules where the perforation 
of the capsular ligament is small and discharge of synovia does 
not immediately follow, there is presented a problem which is 
difficult to decide upon and that is the manner in which such 
wounds are to be handled. One hesitates to enlarge such open- 
ings to drain or irrigate the capsule when there is no proof that 
serious trouble will follow because of infectious material which 
has probably been introduced at the time the wound was in- 
flicted. It is especially difficult to decide upon the manner of 
handling such cases where the tarsal joint is wounded, although 
one hesitates to invade any joint to the extent of incising its 
capsule, unless there is urgent need of so doing. 

Frost ^ offers the following suggestion" in such instances : 
The treatment recommended by us for open joints, in which 
we wish to prevent ankylosis, is, first, to shave all hair from the 
area surrounding the wound, following V\'ith a thorough cleans- 
ing of the skin and disinfection of the v/ound, and then to in- 
ject a twenty per cent Lugol's solution in glycerin into the 
wound. This should be repeated two or three times a day, each 
time enough of the solution being injected to fill the joint cap- 
sule, thereby securing the flushing effect. As this solution does 
not cause irritation to the tissue and yet is a strong antiseptic, 
it serves to shorten the period of congestion and inflammation 
and to overcome the infection without causing a destruction of 
the secreting membrane until the externa] wound has had time 
to heal. The injection of this solution seems to retard the ex- 
cessive secretion of synovia. The larger the joint capsule and 
the smaller the external wound, the longer our antiseptic will 
remain in contact M'ith the inflamed tissues as the glycerin, 
being thick, does not flow through a small opening. 

After-care. — Following the initial cleansing and treatment of 
open joint, sul)se(|uent dressing is necessary as frequently as 
conditions demand. If the parts are l)adly infected and profuse 
discharge of i)us exists a daily change of dressings is necessary. 

'J. N. Frost, assistant professor of Surgery, Veterinary Dept., Cornell 
I'niversity, in "Wound Treatment," page 159. 



ii4 Lameness OF the horsb 

In the average instance, however, semi-weekly treatments are 
sufficient. And in many instances where one is obliged to travel 
a considerable distance to handle the affected animal one weekly 
dressing of the wound will suffice after the second treatment. 

The same general plan of treatment concerning the subject's 
comfort that has been previously mentioned in arthritis, is car- 
ried out here. A further and detailed consideration of the 
subject of handling of open joints follows.^ 

* * * Such wounds may be classified in two general groups 
as follows : First, wounds in which the trauma has exposed 
the articulation to view, and second, those the result of punc- 
tures, in which the external wound is small and free drainage 
is lacking. 

AVounds in which the articulation is exposed to view have 
drainage either all ready provided for, or it is established with- 
out hesitancy surgically. With free drainage thus established 
there is little or no chance for the adjacent tissues to become 
infiltrated with infected wound discharge. This prevents an 
extension of the injury and the establishment of a good field 
for the growth of anaerobic bacteria. 

Open joints caused by punctures, unless the puncture is 
aseptic, produce a swelling which is more painful than is the 
open wound which exposes the joint to view. Especially is this 
true if the puncture is of small diameter, allowing the tissues 
to partially close the opening immediately after the wound has 
been made. Where drainage is lacking there follows an exuda- 
tion which congests the tissues surrounding the injury and all 
factors favoring genn growth are present. It is perhaps advis- 
able to establish good drainage in such cases as soon as a diag- 
nosis is made. 

It is not always an easy matter to recognize an open-joint, 
when first made, but twelve to twenty-four hours later there is 
no cause for doubt. The condition is then a very painful one ; 
lameness is excessive; there is rise in temperature; acceleration 
of the pulse and manipulation or palpation of the region affected, 
occasions great pain. 

The treatment of open joints must be varied to suit the dis- 
position of the animal, the nature and location of the injury, 
the length of time intervening between the infliction of the 
wound and the first attention given, and the surroundings in 
which the patient is kept. 

In each and every case in which there exists an open wound 

'Open Joints and Their Treatment in my practice, by J. V. Lacroix, Amer- 
ican Journal of Veterinary Medicine, Vol. 5, page 203. 



LAMENESS IN THE FORE LEG 115 

the surface surrounding tlie wound is cleansed thoroughly, the 
hair is shaved it' possible, and the margin of the wound is cur- 
retted and cleansed thoroughly with antiseptic solutions. 

If there is evidence that the articulation contains infective 
material, it is washed out with copious quantities of peroxide 
of hydrogen — usually as much as six or eight ounces. This is 
followed by injection of an ounce or two of tincture of iodin. 
Even though the joint appears to be clean some tincture of iodin 
is used, as it checks the secretion of synovia and is, in every 
way, beneficial. Care is taken to apply the iodin also to the sur- 
face immediately surrounding the wound. The entire wound is 
then covered with a dusting powder composed of zinc oxide, boric 
acid, exsiccated alum, phenol and camphor. 

This powder is used in abundance and the wound is then 
covered with a heavy layer of absorbent cotton and well ban- 
daged. This bandage is not disturbed for at least three days 
and may be left in place for a week. In cases in which it is 
necessary to keep the dressing on for a v/eek, or in cases where 
the patient is, through necessity, kept in quarters that are wet 
or unclean, the first bandage is covered with a layer of oakum 
which has been saturated in oil of tar and this in turn is held 
in place by means of several layers of bandages. The bandages 
are also saturated with oil of tar. 

In from one to two months wounds so treated, unless they are 
foot-wounds, will be ready to dress without being bandaged. 
It is ordinarily unnecessary to dress foot-wounds oftener than 
every second week after the discharge of synovia has ceased. 
When the wound has filled with granulation, a protective dress- 
ing is applied which is rendered water proof by the use of 
bandages covered with oil of tar. The patient can now be turned 
out for a month or six weeks without disturbing the dressing. 
After the removal of the bandages, the only treatment necessary 
is an occasional application of some mildly antiseptic ointment. 

Except in nail pricks of the foot, occasioned by punctures, a 
five per cent tincture of iodin is injected into open joints, if the 
wound remains sufficiently open, and this treatment is continued 
so long as there is a discharge of synovia. Surgical drainage is 
established if it is considered practicable and the remainder of 
the treatment is about the same as for wounds which are open. 

Open joints occur in horses at pasture and are sometimes not 
discovered until several days or a week after the injury, and in 
some instances the wounds are filled with maggots. The only 
difference in the treatment of these cases is that more time and 
care is taken in cleansing the wound, more curetting is neces- 
sary, and after cleansing the wound with peroxide of hydrogen, 



116 LAMENESS OF THE HORSE 

the joint is thoroughly washed out with equal parts of tincture 
of iodin and chloroform. This is followed by the injection of a 
quantity of seventy-five percent alcohol and the wound is dressed 
and bandaged as already descrilied. At each subsequent dressing 
of infected wounds so treated less suppuration is noticed and 
the synovial discharge usually ceases in from one to two months. 
About ninety percent of all cases e>f ope)i joint make complete 
recoveries, about four per cent partially recover and six per cent 
are fatal. Among the fatal cases are the open joints with com- 
plications as severed tendons, those occasioned by calk wounds 
in horses that are stabled, and nail punctures of the feet. The 
following report of twelve favorable cases is taken from a record 
of sixty-two cases. The favorable ones are reported, chiefly 
because there are now enough reports on record of such cases 
which have terminated fatally. 

Case 1.— A gray gelding used as a saddle pony received a 
horizontal Avire cut laying completely bare the scapulohumeral 
articulation. The margins of the wound were cleansed as here- 
tofore described, a drainage was provided surgically, tincture of 
iodin was injected and the wound was covered with equal parts 
of boric acid and exsiccated alum. The horse was kept tied and 
a diluted tincture of iodin was injected into the wound once 
daily and the powder applied often enough to keep the wound 
covered. The case made a complete recovery and the pony was 
again in service within sixty days. 

Case 2. — A twelve-hundred-pound bay mare with an open car- 
pal joint. The wound was an open one about two and one-half 
inches in length, and made transversely and when the member 
was flexed the articular surface of the carpal bones were pre- 
sented to view. An ounce of tincture of iodin was injected into 
this joint after having cleansed the margin of the wound and 
the mare was cross-tied in a single stall to keep her from lying 
down. The owner was instructed to keep the outside of the 
wound powdered with air slaked lime and a very unfavorable 
prognosis was given. 

I heard nothing further from this case until fifty-nine days 
from the date of the injury, when I met the owner driving this 
mare to a buggy. The wound had healed by first intention and 
at that time so little cicatrix remained that it was difficult to 
find it. 

Case 3. — A brown mare with an open fetlock joint due to a 
spike-nail puncture. Lameness was excessive, and joint greatly 
swollen. Tincture of iodin was injected into the wound and 
towels dipped in hot antiseptic solutions were applied for several 



LAMENESS IN THE FORE LEG 117 

hours daily until the acute stage had passed. Later the mare 
was turned out to pasture and a vesicant was applied once or 
twice a month until recovery was complete which was in about 
six months. 

Case 4. — A four-year-old bay mare having a wire-cut which 
opened the tarsus joint was treated as heretofore described. The 
wound was kept bandaged for about two weeks and later it was 
dressed without being bandaged. In ninety days she had com- 
pletely recovered. 

Ca,se 5. — A twelve-year-old mare with an open fetlock joint 
due to a puncture wound. The margins of the wound were 
cleansed and the external wound enlarged to facilitate drainage. 
Tincture of iodin was injected; the wound was bandaged and 
dressed for a month in the manner heretofore described, when 
all discharge had stopped. A vesicant was applied; the mare 
was put to pasture and within sixty days from the date of the 
injury she was being driven on short trips. 

Case 6. — A two-year-old brown gelding with a wire-cut on 
the left front foot. The wound extended down through the sole 
and opened the navicular joint. This colt was very wild and it 
was necessary to tie it down each time the wound was dressed 
The wound was dressed weekly for a month and less frequently 
thereafter. It was handled eight times; the last dressing was 
left in place until worn out. Six months later the colt was prac- 
tically well, a very little lameness being shown when walking 
on frozen ground. 

Case 7. — A seven-year-old saddle-horse weighing eleven hun- 
dred and fifty pounds received a wound of the tarsus, laying 
bare the articular surfaces of a part of the joint. It was im- 
possible to keep this wound bandaged because of the restless 
disposition of the subject. Injections of a dilute tincture of 
iodin were employed every second or tliird day for a month 
and the wound was kept covered with the antiseptic dusting 
powder referred to heretofore. In five months complete recovery 
had taken place, with the exception of a stubborn skin disturb- 
ance which was successfully treated six months after the wound 
was inflicted. The horse is still in use and is absolutely free 
from lameness. 

Case 8. — A two-year-old brown gelding with a wire-wound 
0})ening the scapulohumeral joint. This wound Avas large enough 
to expose to view the articular portion of the humerus. The same 
treatment as that given case No. one was instituted and in ninety 
days the colt was i)ractically well. 



118 LAMENESS OF THE HORSE 

Case 9. — A three-year-old bay filly was found at pasture with 
one fore foot badly injured. The owner intended to destroy her, 
but a neighbor prevailed upon him to have her treated. Ap- 
parently the wound was of about a week's standing and in a 
very bad condition, filled with maggots and dirt. Both the 
navicular and coronary articulations were open. This wound 
was cleansed in the usual manner and the owner cared for the 
case the balance of the time because the distance from my office 
was too great to give her personal attention. She made an al- 
most complete recovery in five months. 

Case 10. — At two-year-old mule with an open navicular joint 
due to a barbed wire wound. Usual care was given this case and 
in five months recovery was complete and little scar is to be 
seen. This case received seven treatments. 

Case 11. — An eighteen-months-old colt at pasture was found 
down and unable to rise without help. In addition to several 
wounds of lesser importance there was a large wound on the 
inner side of the elbow, the joint was open and the entire leg 
was greatly swollen and in a sta,te of acute infectious inflamma- 
tion. The colt could not walk, its temperature was 105°, pulse 
was rapid and respiration was a little hurried. After advising 
the owner to put the poor animal out of its misery I left the 
place. Four days later the owner came to my office and asked 
if he could borrow some old shears to "trim off some loose hide 
from that colt." He left the colt in the pasture and all the 
care it received was the regular application of a proprietary 
dusting powder. It made a complete recovery. 

Case 12. — A family mare, heavy in foal, received a vertical 
wound of the fetlock joint inflicted by a disc-harrow. The cul- 
de-sac of the ligament of this joint was opened freely. The 
wound was dressed in the usual manner and again three days 
later when no suppuration had taken place. Four days later 
the patient gave birth to a colt and suckled it right along through 
her convalescence. This wound healed by first intention and 
seventy-nine days from the date of the injury the mare was 
driven to town, two and one-half miles distant, and showed but 
little lameness. 

Phalangeed Exostosis (Ringbone) 

This term is applied to exostoses involving the first and second 
phalanges (suffraginis and corona), regardless of their size, ex- 
tent or location. It is a misnomer, in a sense, and the veter- 
inarian is frequently obliged to spend considerable time with his 



LAMENESS IN THE FORE LEG 119 

clients in order to convince them that a spherodial exostosis of 
the proximal phalanx, in certain cases, is in reality "ringbone," 
even thongh there exists no exostosis which completely encircles 
the afiPected bone. 

Etiology and Occurrence. — Exostosis of the first and second 
phalanges is usually due to some form of injury, whether it be a 
contusion, a lacerated wound which damages the periosteum, or 
periostititis and osteitis incited by concussions of locomotion, 
or ligamentous strain. Practically the only exception is in the 
rachitic form of ringbone which affects young animals. 

There are predisposing causes that merit consideration, chief 
among which is the normal conformation of the coronet joint. 
This proclivity is constant; the normal interphalangeal articula- 
tion is an incomplete ginglymoid joint and while its dorso-volar 
diameter is great, this in no wise compensates for its dispropor- 
tionately narrow transverse diameter. The pivotal strain which 
is sometimes thrown upon this articulation when an animal turns 
on one foot, as w^ell as the tension which is put on the collateral 
ligaments when the inner or the outer v^uarter of the foot rests 
in a depression of the road surface, tends to detach the insertion 
of these ligaments or to cause fibrillary fractures of their sub- 
stance. 

Short, upright, pasterns receive greater concussion during fast 
travel on hard roads than do the longer more sloping and well 
formed extremities. Those who are advocates of the theory that 
this type of osteitis with its complications has its origin in the 
articular portion of the joint, claim that the upright pastern con- 
stitutes an important tendency toward ringbone. Howbeit, ring- 
bone is an active, serious and frequent cause of lameness and it 
affects animals of all ages and occurs under various conditions. 
Horses having good conformation and kept at work wherein no 
great amount of strain is put upon these parts, are occasionally 
victims of this affection. 

Classification. — The arrangement employed by Moller^ is in- 
tensely practical and logical. He considers ringbone as articu- 
lar, periarticular, rachitic and traumatic. A mode of classifica- 

iRegional Veterinary Surgery Midler— Dollar, page 605. 



120 



LAMENESS OF THE HORSE 



tion that is common aud in a practical way, good, is, high and 
low ringbone. When prognosis is considered, for instance, it is 
very convenient to state that the chances for recovery are much 
better in high ringbone than in low ringbone. The classification 
of Moller will be followed here. 

Symptomatology. — In all forms of incipient ringbone except 
rachitic, the first manifestation of its existence, or of injury to 
the ligaments in the region of the pastern joint which causes 




Fig. 17 — Phalangeal exostoses. 

periostitis, or affections of the articular portions of the proximal 
inter-phalangeal joint, is lameness. Lameness which typifies 
ringbone is of the supporting-leg variety and by compelling the 
subject to step from side to side, marked flinching is observed, 
especially in periarticular ringbone ; causing the affected animal 
to turn abruptly on the diseased member, using it as a pivot, 
likewise accentuates the manifestation. In fact, many subjects 
that exhibit no evidence of locomotory impediment while walking 
or trotting in a straight line on a smooth road surface, will mani- 
fest the characteristic form of lameness from ringbone when the 
aforementioned side to side movement is performed. 



LAMENESS IN THE FORE LEG 



121 



When the manner in which pain is occasioned is considered, it 
will be understood why lameness is intermittent in the early 
stages of this affection and may even be unnoticed by the driver. 
An animal may travel on a smooth road without giving evidence 
of any inconvenience, but as soon as a rough and irregular pave- 
ment or road surface is reached, will limp. As the subject is 
driven farther on level streets the lameness may disappear. This 
intermittent type of lameness may continue until there is de- 
veloped a large exostosis, or until articular involvement causes 




I'k,".',':'-' '^S.:>^- ■ ■ ■ - 



Figr. IS — Rarefying: osteitis in ciiionic ringbone and ossification of lateral 
cartilages. 



SO much distress during locomotion that lameness is constant. 
On the other hand, resolution may occur during the stage of 
periosteal inflammation, or, an exostosis forms which causes no 
interference with function. 

Before there is evidence of an exostosis, diagnosis of ringbone 
is not easy, for it is then a problem of detecting the presence of 
a ligamentous sprain, periostitis, or osteitis. The diagnostician 
should take note of local manifestations of hypersensitiveness, or 
heat if such exist, and, in addition, other conditions must be ex- 
cluded before definite conclusions are possible. 

In articular ringbone as soon as there is developed an exostosis, 



122 LAMENESS OF THE HORSE 

it occupies a position on the dorsal (anterior) part of the articu- 
lation and extends around the sides of the joint. 

Periarticular ringbone is characterized by exostoses which 
are situated on the sides of the phalanges and not extending 
around to the anterior part of the joint. This type of ringbone 
as well as the articular may occur "high" or "low." 




Fig. 19 — Phalangeal exostoses in chronic ringbone. Museum specimen of 
the Kansas City "Veterinary College. 

With the traumatic form of ringbone, all consequences, as to 
the size and form the exostosis is to assume, depend upon the 
nature and extent of the injury. 

Rachitic ringbone is frequently observed in some sections of 
the country and does not ordinarily cause much if any lameness. 
It is a disease of colts and may affect one or all of the phalanges 
at the same time. As the subject advances in age there is more 
or less diminution in the size of the enlargements. 



LAMENESS IN THE FORE LEG 123 

Treatment. — Rest is essential in the treatment of ringbone. 
If diagnosed during its incipiency, remedial measures such as 
are usually employed to treat sprains, are indicated and later 
the parts should be ])listered. When an exostosis has developed 
puncture firing is the remedy par excellence. Not that this 
method of treatment is infallible, for to any thinking one who 
takes into consideration the pathological anatomy of this condi- 
tion, it is evident that no manner of treatment is beneficial in 
some cases. If the exostosis is so situated that it does not me- 
chanically interfere with function, and is not so large that it 
may inhil)it flexion and extension, and where the articular por- 
tions of the joint are not eroded, good results attend the use of 
the actual cautery. 

In firing, after having anesthetized the extremity, and pre- 
pared the surgical area, the cautery is deeply inserted in numer- 
ous places, taking care, however, not to open the joint. The parts 
are immediately covered with aseptic absorbent cotton and this 
dressing is left in position for forty-eight hours and if perchance 
there is evidence of synovial discharge, the parts are again 
aseptically dressed in order to prevent infection of the articula- 
tion. If, as is the case usually, no perforation of the joint cap- 
sule exists, the openings made by the cautery have been closed 
by the coagulation of serum and there is then little chance of 
infection causing trouble, even though the member is left un- 
bandaged. 

In several instances, the author has treated ringbone by this 
method where the periarticular type existed and lameness was 
marked, and in three weeks the subjects were in service and not 
lame — this, in one instance in a valual)le polo pony where the 
subject continued in service for more than a year without any 
evidence of recurrence of the lameness. The production of a 
deep-seated and acute inflammation with the actual cautery is 
preferable to any sort of counter-irritation Avhich may be pro- 
duced by vesicants. 

There is no occasion for any difference in the treatment of 
either of the first three classes of ringbone, but in the rachitic 
type where treatment is given, the application of a vesicant is 



124 LAMENESS OF THE HORSE 

all that is required. In most instances treatment is not neces- 
sary. 

The affected animals require a month to three months' time 
for recovery to take place in the average favorable cases of ring- 
bone. 

Median neurectomy is of service in many instances where 
lameness is not completely relieved by the use of the actual 
cautery and no bad results attend the performance of this opera- 
tion even though no benefit is derived thereby. Plantar neu- 
rectomy is contraindicated in all cases where there exists much 
lameness. If lameness is due to acute inflammation bad results 
such as sloughing and loss of the hoof may follow; and if large 
exostoses mechanically interfere with function of the joint, or 
where articular erosions exist, no possible good can come from 
neurectomy. Careful discrimination should be employed in se- 
lecting cases for neurectomy for this operation ; otherwise, it is 
very likely to prove disappointing. 

Open Sheath of the Flexors of the Phalanges. 

This condition does not differ from a like affection involving 
other tendons except that the function of these tendons is such 
that large synovial sheaths are necessary, and when synovitis 
exists, the condition then becomes more serious. 

Infectious synovitis involving these tendons in the fetlock 
region is of more frequent occurrence than a like affection of 
carpal or tarsal sheaths. With the exception of the extent of 
the involvement and distress occasioned thereby, synovitis the 
result of open tendon sheaths, is similar wherever it occurs. 

Etiology. — The same conditions which are responsible for 
open fetlock joint and other wounds of the pastern region, cause 
open tendon sheaths of the flexor tendons. 

Symptomatology. — Because of the size and extent of this 
sheath and the different manner in whicli it is opened, there is 
manifested dissimilar symptoms in different cases. A nail 
puiTcture which perforates the sheath in the pastern region and 
at the same time produces an infectious synovitis, will cause 
a markedly different manifestation than will a wound which 



LAMENESS IN THE FORE LEG 125 

freely opens the sheath al)ove the fetlock. In the first instance, 
the condition is much more painful ; swelling is intense in some 
cases; and if the subject does not possess sufficient resistance so 
that spontaneous resolution promptly occurs, surgical evacua- 
tion of pus is usually necessary. When these tendon sheaths 
are opened, there follows a reaction which is quite analogous to 
that which exists in arthi'itic synovitis, but instead of ankylosis, 
adhesions with thecal obliteration occur. Rarely there result 
cartilaginous and osseous formations. 

The constitutional disturbances whicli characterize this con- 
dition vary with the degree of distress occasioned. As the in- 
fection is virulent and causes serious destruction of the affected 
parts, so does evidence of malaise and iinally distress appear. 
Detailed discussions of symptomatology in similar conditions 
have heretofore been given, and furthei- repetition is unneces- 
sary. 

Treatment. — The same general plan of treatment which is 
employed for handling open joint is put in practice in these 
cases. Following the preoperative cleansing of the external 
wound and adjacent surfaces, where liberal drainage exists, 
tincture of iodin is injected into the sheath, the parts covered 
with a suitable dressing powder, and th^ entire member is care- 
fully dressed with cotton and bandages. 

Subsequent treatment is the same as has been outlined ni the 
discussion of open fetlock joint on page 112. The same general 
plan of after-care is necessary. Recovery, however, does not 
require so much time ordinarily, yet punctures of the sheath 
occasioned by nails or other small implements make for long 
drawn out cases of infective synovitis. 

Luxation of the Fetlock Joint. 

Etiology and Occurrence. — Tiu^ manner of construction of 
the fetlock joint is such that disarticulation without iri'eparable 
injury resulting, is practically impossible. Logically, this joint 
in the fore legs (not so in the pelvic limbs) should disarticulate 
in such manner that either all of the inhibitory apparatus (flexor 
tendons and suspensory ligament) nnist rupture or a lateral 
luxation is necessary. Lateral disarticulation must necessarily 



126 LAMENESS OF THE HORSE 

sever the attachment of one of the common collateral ligaments. 
Because of the width (transverse diameter) of the articulating 
surfaces of this joint, lateral luxation requires a great strain; 
and a force that is sufficient to occasion this trauma usually 
causes serious additional injury. Therefore, the condition is 
considered one wherein prognosis is always unfavorable in so 
far as practical methods of treatment are concerned. 

Mr. A. Barbier^ reports a case of bilateral luxation of the fet- 
lock joints of the hind legs in a horse. This was done in jump- 
ing, and the extensor tendon of each leg was ruptured and the 
anterior portion of the metatarsus was protruding tlirough the 
skin. Profuse hemorrhage had taken place due to tearing of 
the blood vessels. 

Symptomatology. — Entire luxation of this joint when present 
is so evident that one cannot fail to recognize the condition. 
Complete disarrangement of normal relation occurs and there is 
either a breaking down of the inhibitory apparatus, or if a lateral 
disarticulation exists, the normally straight line formed by the 
bones of the front leg, as viewed from the front or rear, is broken 
at the fetlock. 

Often fracture of bones are concomitant and then, of course, 
mobility is increased and not decreased as is the ease in un- 
complicated luxation. 

Such violence occurs at times, when this joint is disarticulated, 
that the joint capsule is also completely ruptured and the articu- 
lar portion of the bones is exposed to view. 

Treatment. — The condition being practically a hopeless one, 
destruction of the subject is the thing which should be promptly 
done. In valuable breeding animals, owners may prefer that 
treatment be attempted when a lateral luxation and detachment 
of but one common ligament have permitted luxation without 
complete disarticulation and rupture of the joint capsule. In 
such cases, by immobilizing the affected parts as in fracture, 
and confining the subject in a sling for about sixty days, partial 
recovery may occur in some instances. 

Experience has shown that where luxation with detachment of 



^Extract from Receuil de M6decine Vgt^rinaire in Ameircan Veterinary 
Review, Vol. 23, p. 893. 



LAMENESS IN THE FORE LEG 127 

a collateral ligament occurs, recovery is slow and incomplete — 
there always results considerable exostosis at the site of injury. 

Sesamolditis. 

Etiology and Occurrence. — Inflammation of the proximal 
sesamoid bones is caused by any kind of irritation which may 
involve this part of the inhibitory apparatus. Positioned as 
they are, between the bifurcations of the suspensory ligament 
and the pastern joint, they serve as fulcra and effectively assist 
in minimizing concussion which is received by the suspensory 
ligament. The flexor tendons also, in contracting, exert strain 
upon the inter-sesamoidean ligament, which has a similar effect 
upon the sesamoid bones as that which is produced by the sus- 
pensory ligament. 

The condition occurs quite frequently, and because of the 
important function performed by these bones, active inflamma- 
tion of the sesamoids constitutes a serious affection. Because 
of the fact that these bones have proportionately large articular 
surfaces, when they are inflamed to the extent that degenerative 
changes affect the articular cartilage, complete recovery seldom 
results. 

The same pathological changes occur here that are to be seen 
in any case of arthritis. No special pathological condition char- 
acterizes sesamoiditis but this condition causes incurable lame- 
ness when the sesamoid bones are much inflamed. 

Symptomatology. — In acute inflammation, there exist all tlie 
symptoms which portray any arthritic inflammation of like char- 
acter. The parts are readily palpable and are found to be hot, 
supersensitive, and more or less infiltration of the tissues con- 
tiguous to the joint causes swelling. There is volar flexion of the 
phalanges when the subject is at rest. Lameness is intense; in 
some acute inflammatory disturbances the subject is unable to 
bear weight on the affected member. 

In chronic sesamoiditis, constant lameness is the one salient 
feature which marks the condition. "While it is possible for one 
sesamoid bone to become involved without its fellow being af- 
fected, this is not usual. Considerable organization of tissue 
surrounding the joint is present and no particular evidence of 



128 LAMENESS OF THE HORSE 

supersensitiveness exists. However, supporting weight brings 
sufficient pressure to bear upon the inflamed and more or less 
eroded bones so that pain is occasioned and lameness results. 

Treatment.— During acute inflammation, absolute quiet is, 
of course, of first consideration. Cold packs are to be kept in 
contact with the parts until acute inflammatory symptoms sub- 
side. The fetlock region is then enveloped with a poultice or an 
iodin and glycerin combination (iodin one part to seven parts 
of glycerin) is applied and a dressing of cotton is kept in con- 
tact with the inflamed region. Following this, a vesicant is em- 
ployed and the subject is allowed a month's rest. 

In sub-acute cases, the entire region surrounding the pastern 
is blistered or the actual cautery is used. Line-firing is pref- 
erable. The subject is given a month or six weeks rest and one 
may be guided by the presence or absence of lameness as to 
whether improvement or recovery is taking place. 

Old chronic cases, and particularly those where there are con- 
siderable induration and fibrous organization of tissue surround- 
ing the joint, are not to be benefited by treatment. 

The chief consideration in handling sesamoiditis is checking 
inflammation as early as possible and preventing, if this can be 
done, the erosion of articular surfaces. If destruction of any 
part of the articular surfaces can be prevented and the patient 
allowed ample time for complete resolution of the affected parts 
to occur, permanent relief is possible. 

Fracture of the Proximal Sesamoids. 

Etiology and Occurrence. — Fracture of the proximal sesa- 
moid bones is caused by violent strain when there exists fragilitas 
osseiim, or by contusions. The author treated a case where 
fracture of one sesamoid was occasioned by a horse receiving a 
puncture wound wherein the sharp end of a steel bar w^as pro- 
truding from the ground where it was firmly embedded. The 
subject in this case was injured while being driven along a 
country road. Frost^ reports simultaneous fracture of all of the 
proximal sesamoids occurring in a sixteen-year-old pony. The 



^Fracture of All the Sesamoid Bones, by R. F. Frost, 1<I. R. C. V. S., 
A. V. D., Rangoon, Burmah, in American Veterinary Review, Vol. 5, p. 362. 



LAMENESS IN THE FORE LEG 129 

condition is of rather common occurrence in some countries be- 
cause of the fragile condition of horses' bones. 

Symptomatology. — If the parts can be examined before ex- 
travasation of blood and swelling mask the condition, crepita- 
tion may be detected. In other instances, it is possible to note a 
displacement of parts of the sesamoid bones — this in horizontal 
fracture. There occurs more or less descent of the fetlock which 
must not be attributed to rupture of the superficial Hexor tendon 
(perforatus). By outlining the course of this tendon with the 
lingers, when it is passively tensed sufficiently to follow its course, 
one may exclude rupture of the superficial Hexor. Finding the 
suspensory ligament intact from its origin to the sesamoid at- 
tachments, one may also eliminate rupture of this structure as 
a cause of the trouble. Needless to say, marked lameness and 
swelling of the fetlock soon take place. The condition is painful, 
and ordinarily, recovery is impossible. 

Treatment. — AYhere treatment is attempted, immobilization 
as in luxation is in order. The patient's comfort is sought, and 
if the fractured parts can be kept in close proximity, their union 
may occur in time. However, chances for partial recovery 
(which is the best to be hoped for) are so remote that early de- 
struction of the subject is the humane and economical thing to 
do. 

AVhere treatment is instituted, it is found that there is required 
a long time for union of the fractured bones to occur (where 
union does take place) and the cost of treatment together with 
the uncertainty of even partial recovery, makes for an unfavor- 
able outcome. When the best possible results succeed treatment, 
a large callosity is formed and movement of the pastern joint 
is restricted. Lameness, though not intense, in the case referred 
to, where one bone was broken, was permanent and the subject 
was out of service for nearly a year. 

Inflammation of the Posterior Ligaments of the Pastern (Prox- 
imal Interphalangeal ) Joint. 

Anatomy. — The ligaments here involved are the four volar 
ligaments described by Sisson^ as follows: "The volar ligaments 



'The Anatom>- of the Domestic Animal, by Septimus Sisson, S. B., V. S. 



130 LAMENESS OF THE HORSE 

(Ligg Volaria)i consist of a central pair and a lateral and me- 
dial bands which are attached below to the posterior margin of 
the proximal end of the second phalanx and its complementary 
fibro-cartilage. The lateral and medial ligaments are attached 
above to the middle of the borders of the first phalanx, the cen- 
tral pair lower down and on the margin of the triangular rough 
area. ' ' 

This portion of the inhibitory apparatus is described by 
Strangeways' Anatomy as two posterior ligaments which run 
each from three points on the sides of the os suffraginis to a 
piece of fibro cartilage, described as the glenoid cartilage, and 
attached to the postero-superior edge of the os coronae ; between 
them is the insertion of the inferior sesamoidean ligament. 

Etiology and OccuiTence. — Everything tending to increase 
strain upon these ligaments is contributory to possible fibrillary 
fracture of these structures. Excessive leverage as furnished 
by long toes, long toe-calks and low heels increases the normal 
tension on the posterior ligaments of the pastern joint. Faulty 
conformation, which throws an abnormal strain on these liga- 
ments, is a predisposing cause of inflammation of these struc- 
tures. Hard pulling upon slippery and rough or frozen roads 
is a common exciting cause of this injury. The condition is of 
comparatively frequent occurrence and is seen affecting draft 
horses frequently, in the hind legs. 

Symptomatology. — Lameness is the first manifestation of this 
affection and weight bearing is painful in direct proportion to 
the extent of injury present. Volar flexion of the phalanges 
relieves tension on the parts; therefore, this position is assumed 
while the subject is at rest. When considerable tissue has been 
ruptured, and the condition is very painful, the foot is held off 
the ground as in all painful affections of tlie extremity. 

By palpation evidence of pain is discernible, though very little 
swelling occurs. Pain is increased by manual tension of the 
parts which is done by grasping the toe of the foot and exerting 
traction on the flexor apparatus. Care must be t^ken in execut- 
ing such manipulations, and it is only by comparison of the 
affected member with the sound one and noting the difference 



LAMENESS IN THE FORE LEG 131 

in the manifestations of discomfort that we may arrive at the 
proper conclusion. 

Some hyperthermia is to be recognized in acute inflammation, 
by comparing the extremities. In the fore legs, navicular disease 
is differentiated by noting absence of contraction at the heel. 
By use of the hoof testers one may recognize evidence of inflam- 
mation of the navicular apparatus. In inflammation of the pos- 
terior ligaments of the pastern joint, there is also al)sence of the 
characteristic stumbling which is seen in navicular disease. 

Treatment— Rest is the first requisite, and in addition every 
mechanical means possible to change the center of gravity in 
the phalangeal region, is to be employed. This is best accom- 
plished by shortening the toe and paring the sole at the toe as 
much as conditions will permit. The heel is raised by means 
of a shoe with moderately high heel calks. 

The iodin-glycerin combination heretofore mentioned may be 
applied and the parts covered with cotton and bandage. Sub- 
jects require froin three weeks to several months' rest and must 
be returned to work carefully, lest the incompletely regenerated 
tissues suffer injury. 

Regeneration of tissue in such cases, as has been pointed out, 
is slow and sufficient time for complete recovery must be al- 
lowed or relapses will occur. 

Fracture of the First and Second Phalanges. 

Etiology and Occurrence. — Fractures of the first plialanx 
(suffraginis) occur with respect to frequency, second to pelvic 
fractures. Often, almost insignificant injuries cause phalangeal 
fractures. On city streets, horses shod with shoes having long 
calks get caught in frogs of street railways or by slipping on 
rails, and phalangeal bones are often broken. The author ob- 
served a case of comminuted fracture of both the first and sec- 
ond phalanges (suffraginis and corona) in a polo pony caused 
])y making a sudden turn while in action in a contest on the turf. 

Symptomatology. — Fracture of the phalanges is nearly al- 
ways signalized by lameness, and this is marked during the pe- 
riod of weight bearing. Lameness is usually intense and where 



132 LAMENESS OP THE HORSE 

the pathognomonic symptom (crepitation) is not recognized, the 
intensity of the claudication, when other causes are absent, is 
indicative of fracture. The subject does not bear weight upon 
the affected member and where pain is intense, the foot is held 
in an elevated position and swung back and forth. In hind legs 
the member is often flexed in abduction and held in this position 
for several minutes, being rested on the ground only during 
short intervals. When compelled to walk, if pain is excruciating, 
the animal hops with the sound leg, no weight being supported 
by the fractured member. 

When an examination of the subject is possible before the 
extremity is swollen, crepitation is usually found without great 
difficulty, except in a subperiosteal break or in some cases of 
vertical or oblique fracture. Great care is necessary in handling 
the injured extremity in these cases, and particularly in nerv- 
ous subjects or in excited animals that have been recently in- 
jured in runaways, is it necessary to be gentle in manipulating 
the extremity, if definite deductions are to be made. As has 
been mentioned in the chapter on diagnostic principles, if the 
condition is so painful that the subject does not relax the parts 
and crepitation is masked, local anesthesia is necessary. An 
anesthetic solution of cocain or novocain may be applied to the 
metacarpal or metatarsal nerves and an entirely satisfactory 
examination is then possible. 

Passive movement of the phalanges in all directions is prac- 
tised in order to produce crepitation. When rotation of the 
parts does not occasion crepitation, gentle flexion and extension 
may do so. And in many instances, considerable manipulation 
of the phalanges is necessary before the pathognomonic sjnnptom 
is to be recognized. 

In cases where crepitation is not found and lameness is pro- 
nounced, out of proportion Avith other possible existing causes, 
one may by exclusion of other causes establish a diagnosis of 
fracture in the course of forty-eight hours. In the meanwhile, 
support is given the affected member by applying an effective 
leather splint, so that pain may be diminished. To combat in- 
flammation, a suitable cataplasm may be applied directly to the 
skin, the extremity bandaged, and the temporary immobilizing 



LAMENESS IN THE FORE LEG 133 

api)liance may be secured over all. In this manner one may 
make repeated examinations of the subject, and if slings are 
used and every other necessary precaution taken to promote 
comfort for the subject, no harm will result in delaying for 
several days the application of permanent imm()l)ilization — ban- 
dages and splints or casts. In fact, where much swelling exists 
at the time one is called to treat such eases, it is advisable to delay 
the application of a permanent dressing or cast until inflamma- 
tion has somewhat subsided. 

Course and Prognosis. — Where conditions are favoral)le, the 
nature of the fracture one that will yield to treatment, the sub- 
ject not aged, and facilities for giving good attention to the 
affected animal are ample, fractures of the first and second 
phalanges recover completely in from six weeks to four months. 
Only simple fractures are considered curable from a practical 
and economical point of view, excepting in foals, where com- 
pound, and even comminuted, fractures niay be so handled that 
animals may eventually become serviceable though blemished. 

Age retards the process of osseous regeneration, but in one 
instance at the Kansas City Veterinary College, a very aged 
mare suffering from a multiple fracture of the first phalanx was 
treated and at the end of sixty days was able to walk into an 
aml)ulance. Large exostoses had developed and the subject re- 
mained lame, but union of the ])roken bone. took place in a sur- 
prisingly prompt and effective manner, when age of the subject 
and nature of the fracture are considered. 

As a rule, one is loath to recommend treatment, even in a sim- 
ple transverse fracture of the first plialanx, in animals ten years 
of age or older. The conditions which exist in any given locality 
that regulate the expense of caring for an animal during the 
period of treatment, especially inHuence the course to be pur- 
sued in treating fractures. 

Treatment. — For permanent immobilization of the phalanges 
in fracture, materials which might adapt themselves to the irreg- 
ular contour of the meml)er and at the same time contribute suf- 
ficient rigidity to the ]iarts without doing injury to the soft 



134 LAMENESS OF THE HORSE 

structures, would constitute ideal means of treatment; but no 
such materials have yet been devised, and opinions are various 
as to the most efficient and practical method to employ. 

After the fetlock has been shorn of hair and the ergot trimmed, 
the skin is thoroughly cleansed and allowed to dry. Several 
thin layers of long fiber cotton are then wrapped around the 
extremity — enough to pad well the member — and this is retained 
in position with a wide bandage. Gauze bandages are prefer- 
able to heavier bandages of cotton fabric because they are some- 
what more elastic and yield to the irregular contour of the parts 
to a better advantage. Layers of three inch gauze bandages, 
which are soaked with a cold starch paste are wound about the 
extremity. Strips of leather that are flexible and not more than 
an inch in width are placed in a vertical position around the 
leg and these are also covered with the starch and securely held 
in position with the bandages. In this way, one is able to pro- 
vide a sufficient degree of rigidity and at the same time, where 
the cast is carefully applied, little if any injury is done the skin. 
Such a cast is not difficult to remove and is so inexpensive that 
it may be removed and reapplied at any time it should be 
thought preferable to do so. Of course, this does not constitute 
an effective means of support if the parts are to be frequently 
and thoroughly soaked with water, but animals undergoing this 
sort of treatment are usually kept sheltered. 

The same after-care is necessary in such cases as is given in 
fractures of other bones. Two months after the injury has 
been done, the application of a blistering ointment to the entire 
region is of benefit. 

Results. — Much depends on the nature of fractures as to the 
success one may attain in approximating the parts of a broken 
bone, and in some cases of oblique fracture for instance, com- 
plete recovery is impossible, despite the most skillful and pains- 
taking attention given. On the other hand, cases of simple 
transverse fractures make perfect recoveries in some instances. 
All fractures are serious, and in every instance the practitioner 
would best be careful to impress his client with the many diffi- 
culties which usually attend the treatment of fracture in horses. 



LAMENESS IN THE FORE LEG 135 

Tendinitis. 
Inflammation of the Flexor Tendons. 

One of the most common causes oi' lameness in light harness 
and saclcUe horses is tendinitis, and because of the character of 
the structure of tendons and because of their function, an active 
inflammation of these parts is always serious. 

Being" almost inelastic and not well supplied with blood, ten- 
dinous tissue is slowly regenerated, and so much time is required 
for complete recovery to take place in tendinitis, that affected 
animals seldom fully recover l^efore they are in service or vig- 
orously exercising at will. As a result, complete recovery is de- 
layed or prevented. 

The extensor tendons, because of the nature of their function, 
are very seldom strained ; they are often bruised and occasionally 
divided, but unlike this condition in the flexors, tendinitis of 
the extensors is of rare occurrence. 

For a concise discussion of this subject the most practical 
classification is one made on a chronological basis and we may 
then consider tendinitis as acute and clironic. 

ACUTE TENDINITIS. 

Etiology and Occurrence. — Causes of tendinitis, as in almost 
all diseases, may be considered under the heads of predisposing 
and exciting. Among the predisposing causes of tendinitis may 
be mentioned, faulty conformation. Everything which has to 
do with increasing the strain upon tendons adds to the proba- 
bility of their being over-taxed. Long, sloping, pastern bones; 
disproportionate development of parts, such as a heavy body 
and small, weak tendons and long hoofs, are the principal fac- 
tors which usually predispose to tendinous sprains. Degenera- 
tive changes which take place in tendons following constitu- 
tional diseases such as influenza may also be classed as a predis- 
posing cause. 

Excessive strain when put upon tendons in any possible man- 
ner, such as is occasioned in running and jumping; making mis- 
steps and catching up the weight of the body with one foot, when 
the force thus thrown upon the supporting structure is great 



136 LAMENESS OP THE HORSE 

because of momentum gained at a rapid pace, are exciting 
causes of tendinitis. 

Symptomatology. — In all eases of acute tendinitis there is 
presented a characteristic attitude l)y the subject. Volar flexion 
in a sufficient degree to relax the inflamed structures is always 
evident. The foot may be rested on the toe or placed slightly 
in advance of the one supporting weight, hut the fetlock is al- 
ways thrown forward. More or less s^^'elling of the inflamed 
tendons is present. Where the deep flexor (perforans) is in- 
volved swelling is marked and with swelling there is present 
the other symptoms of inflammation — heat and supersensitive- 
ness. 

In manipulating tendons for the purpose of detecting super- 
sensitiveness, care must be taken so that no false conclusion 
be drawn, because of the aversion many horses have to submit- 
ting to palpation of the tendons even when they are in a normal 
condition. 

Supporting-leg-lameness is present and varies in degree with 
the intensity of the pain caused by weight bearing. In many 
instances, as soon as the subject has traveled a considerable dis- 
tance, lameness diminishes or discontinues. As soon as the af- 
fected animal is permitted to stand long enough to "cool out" 
there is a return of the lameness, which is then marked. 

No difficulty is encountered in making a practical diagnosis 
in tendinitis; that is, one may fail to readily recognize the ex- 
tent of the involvement as it affects the superficial flexor tendon, 
for instance, but this has no practical bearing on the prognosis 
and treatment, when existing inflammation of the deep flexor is 
recognized. 

The course of each tendon is readily outlined by palpation; 
all parts are easily manipulated ; and with experience one may 
readily recognize the extent and degree of the inflammation. 

Treatment. — In some cases of acute tendinitis, pain is intense 
and the application of cold packs during this stage is very 
beneficial in that pain is controlled and inflammation subsides. 
The extremity may be bandaged with a liberal quantity of ab- 
sorbent cotton or with woolen material. Ice water is then poured 



LAMENESS IN THE FORE LEG 137 

around the bandaged member every fifteen minutes and this 
should be continued for about forty-eight hours. In some cases 
this treatment is not necessary for more than twelve hours; at 
the end of this length of time, pain has subsided and the acute 
stage of inflammation has passed or its intensity has been dimin- 
ished. 

Following the application of cold packs, the use of a poultice 
such as some of the sterile, medicated muds, is of marked ben- 
efit. The author has made use of tincture of iodin and glycerin 
in the proportion of one part of iodin to seven parts glycerin, 
with very satisfactory results. This combination is hygroscopic, 
anodyne and antiseptic and is easily applied. A liberal quan- 
tity is directly applied all around the affected tendons and tlie 
leo- covered with n heavy layer of cotton, and this is snugly 
held in position with liandages. The application may be used 
once or twice daily, or if it is thought necessary, an attendant 
may pour a quantity of the iodized-glycerin around the leg and 
under tlie bandage once daily without removing the cotton and 
bandage. Needless to say, absolute rest is imperative. 

When all evidence of acute inflammation has subsided vesica- 
tion is indicated. At this sta^^e walking exercise is beneficial 
and the subject may be allowed the freedom of a paddock. 

Rome practitioners are partial to the use of the actual cnutery 
in these cases, but it is doubtful if it is necessary to produce 
such a great degree of counter-irritation in cases where the sub- 
ject is suffering the first attack of tendinitis. 

As has been indicated, ample time should be allowed for re- 
covery and depending upon conditions, it takes from three weeks 
to six months for complete recovery to become established. 

Chronic Tendinitis and Contraction of the Flexor Tendons. 

Etiology and Occurrence. — Acute inflammation of the flexor 
tendons may result in chronic tendinitis. Recurrent attacks in 
eases where insufficient time is allowed for complete recovery 
to result, is followed by chronic inflanniiation and hypertrophy 
of the tendons. Again, in subjects where conformation is fault3^ 
no amount of care will 1)e sufficient to prevent a recurrence of 
the inflammation and the condition must become chronic. 



138 LAMENESS OF THE HORSE 

Symptomatology. — On visual examination of the subject at 
rest, one may note the hypertrophied condition of the affected 
tendons. Their transverse diameter is usually perceptibly in- 
creased and in many cases, there is an increase in the antero- 
posterior diameter. The latter condition causes a bulging of 
the tendon that is so noticeable, because of the convexity thus 
formed, it is commonly known as "bowed tendon." 

In chronic tendinitis there occurs repeated attacks of inflam- 
mation wherein lameness is pronounced and there exists in real- 




Fig. 20 — ^Contraction of the superficial digital flexor tendon (perforatus) of 
the right hind leg, due to tendinitis. 

ity, at such times, acute inflammation of a hypertrophic struc- 
ture, where at no time does inflammation completely subside. 
Therefore, in chronic tendinitis there is to be found at times the 
same conditions which characterize acute inflammation, except 
that there is usually a variance of symptoms because of the dif- 
ference in the degree of inflammation and pain. 

The diagnosis of contraction of tendons is an easy matter be- 
cause of the fact that relations betM^een the phalanges are con- 
stantly changed with tendinous contraction. If one bears in 
mind the attachments and function of the digital flexors, no 
difficulty is encountered in recognizing contraction of either ten- 
don. 



LAMENESS IN THE FORE LEG 



139 



Contraction of the superficial digital flexor (perforatus), when 
uncomplicated, is characterized by vollar flexion of the pastern 
joint. The foot is flat on the ground and the heel is not raised 
because the superficial flexor tendon does not have its insertion 
to the distal phalanx (os pedis) and therefore can not affect the 
position of the foot. 

By causing the subject to stand on the affected member, one 




Fig. 21 — Contraction of tiie deep flexor tendon (perforans) of the riglat liind 
leg, due to tendinitis. 

may outline the course of the flexor tendons by palpation, and 
in this way recognize any lack of tenseness or contraction of 
tendons or of the suspensory ligament. 

Contraction of the suspensory ligament would cause the pas- 
tern joint to a.ssume the same position as is occasioned by con- 
traction of the superficial digital flexor (perforatus) tendon, but 
when the subject is bearing weight on the affected member, it is 
easy to determine that no contraction of the suspensory liga- 



140 



LAMENESS OF THE HORSE 



ment exists, by noting an absence of abnormal tenseness of this 
structure. And finally, contraction of the suspensory ligament 
is of rare occurrence. 

Contraction of the deep flexor tendon (perforans) causes an 
elevation of the heel. The foot can not set flat bedaTlsfeT the in- 
sertion of the deep flexor tendon to the solar surface of the distal 
phalanx (os pedis) causes — when the tendon is contracted — a 
rotation of the distal phalanx on its transverse axis — hence the 




Fig. 22 — A chronic case of contraction of both flexor tendons of the pha- 
langes. In this case (presented at a clinic of the Kansas City Veterinary 
College) because of long continued contraction of the flexors, which pre- 
vented weight being supported with any degree of comfort, there resulted a 
partial paralysis of the extensors, and consequently the extremity was 
dragged on the ground. 

raised heel. No other tendon has this same effect on the distal 
phalanx and the condition is correctly diagnosed without diffi- 
culty. 

Course and Complications. — This condition may exist for 
years without causing the subject any serious inconvenience, if 
the affected animal is kept at suitable work. In other instances 
recurrent attacks of lameness are of such frequent occurrence 
that the subject is not fit for service. Many affected animals 
that are kept in service in spite of lameness (and in some in- 



LAMENESS IN THE FORE LEG 



141 



stances where no lameness is present), soon become unservice- 
able because of contraction of the inflamed tendon. This, in 
fact, is the condition which oventually ))ecomes establislied in 
most instances. 

Treatment. — Where conformation is not too faulty so that 
recovery may be expected, good results are olitained by line- 
firing the tendons and allowing the sul)ject a few months' rest. 




JSBI^iii 



Fig. 23 — Contraction of the superficial and deep flexor tendons (perforatus 
and perforans) of the left fore leg. 

In some cases median neurectomy is advisable. This is recom- 
mended by Breton^ as being productive of good results even 
where contraction of tendons exists and tenotomy is done. 

By shoeing with high heel-calks considerable strain is taken 
from the inflamed tendons because of the changed i)osition of 
the foot which alters the distrilnition of weight on different parts 
of the log. Rubber pads materially diminish concussion and 

'Trait4 De Therapeutique Chirurgicale Des .\iiim:nix Donie-stifiuc, par P .) 
Cadiot et J. Ahny, Tome Second, page 547. 



142 



LAMENESS OF THE HORSE 



should be made use of when the subject is returned to work, if 
the character of the work is such as to occasion much concussion. 
It is to be remembered, however, that in sprains there occurs 
fibrillary fracture of soft structures and time is required for 
regeneration of tissue which has been injured or destroyed. Ab- 
solute rest is necessary where inflammation is acute and in sub- 
acute or chronic tendinitis avoidance of all Avork which causes 
irritation to the affected tendons is imperative. 




Fig-. 24 — Contraction of superficial digital flexor and slight contraction of 
deep flexor tendon. 



Where contraction of tendons exists surgical treatment is nec- 
essary. No good comes from appliances which are calculated to 
stretch the affected tendons ; in fact, they aggravate the inflamed 
condition and hasten complete loss of function of the affected 
member. Where there exists no articular or ligamentous dis- 
eases which would defeat the purpose, tenotomy is the only 
remedy for contracted tendons. 



LAMENESS IN THE FORE LEG 143 

Contracted Tendons of Foals. 

Etiology and Occurrence. — This condition is occasionally ob- 
served and no positive explanation of the reason for its exist- 
ence can be given. That mal-position en utcro causes the meta- 
carpal bones to develop in length so rapidly that the tendons 
are too short, is an explanation that is offered. Be that as it 
may, in breeding sections of the country the general practitioner 
is obliged to handle these cases and successful methods of treat- 
ment are essential even though cause is not removable. 

Symptomatology. — The superficial flexor tendon (perforatus) 
alone, is the one usually contracted, and while both flexors are 
at times involved, this rarely occurs. The condition is usually 
bilateral. 

The degree of contraction varies greatly in different cases. 
In some, contraction exists to such extent that it is impossible 
for the colt to stand, and because of continual decubitus where 
no relief is given, the subject is lost because of gangrenous in- 
fection occasioned by bed sores. Otherwise the same symptoms 
are to be observed in this condition, that exist in contraction of 
tendons of the mature animal. 

Treatment. — Wherever contraction is not too marked and 
weight is borne with the affected members, and where the feet 
can be kept on the ground in a nearly normal position, it is pos- 
sible to correct the condition without doing tenotomy. That is, 
in cases where the subject is simply "eock-ankled", where volar 
flexion of the pastern joint exists but the foot is kept flat on the 
ground, correction is possible without tenotomy. 

In such instances the foal must be treated early — before the 
skin on the anterior pastern region has been badly damaged by 
knuckling over. It is possible in many eases to stretch the flexor 
tendons by grasping the colt's foot with one hand, and with the 
other hand one may push the pastern in the direction of dorsal 
flexion. This may be tried and when a reasonable amount of 
force is employed, no harm is done, even though no material 
benefit results. Some veterinarians claim good results from this 
treatment alone and direct their clients to repeat the stretching 
process several times daily. 



144 LAMENESS OF THE HORSE 

Whether the tendons are manually stretched or not, splints 
should be adjusted to the affected members. The legs are padded 
with cotton and bandages and a suitable splint is applied on 
either side of the members and securely fixed in position liy 
bandaging. 

The splints are kept in position for four or five days and then 
removed for inspection of the affected parts. If necessary, they 
are reapplied and left in position for a week; however, this is 
unnecessary in the average case that is treated in this manner. 

Where contraction exists to the extent that the subject can 
not stand and where no weight is borne by the feet, it is neces- 
sary to divide the affected tendons surgically. The same technic 
is put into practice that is employed in the mature subject but 
there is much greater chance for a favorable outcome in the foal. 
Further, if necessary, one may divide with impunity, both ten- 
dons on each leg, at the same time. In all cases this operation 
is done by observing strict aseptic precautions and the legs are, 
of course, bandaged. If both tendons are divided, splints should 
be employed and kept in position for ten days or two weeks. 
Primary union of the small surgical wound of the skin and 
fascia occurs in forty-eight hours. 

The reader is referred to William's "Veterinary Surgical 
and Obstetrical Operations," for a complete description of this 
operation. 

In veterinary literature there is occasionally described a con- 
dition which affects young foals wherein symptoms similar to 
those of contraction of the flexors are manifested, but upon 
examination it is found that rupture of the extensor of the 
digit (extensor pedis) exists. This affection is briefly described 
by Cadiot but no complete treatise on this condition has been 
published. 

In parts of Canada foals of from one to three days of age 
are found affected in such manner that more or less interference 
with the gait is to be seen in those moderately affected. There 
is, in some subjects, only a slight impediment in locomotion 
which is occasioned by inability to properly extend the digit. 
In other subjects, while able to stand and walk, great difficulty 
is experienced because of volar flexion of the phalanges. The 
more seriously affected animals are unable to stand and, in most 
instances, perish because of the effects of prolonged decubitus. 



LAMENESS IN THE FORE LEG 145 

A local enlargement occurs at the anterior carpal region and 
the mass is somewhat fluctuating, extravasated fluids becoming 
infected in many instances, and necrosis of the skin and fascia 
provide means for spontaneous discharge of the contents of 
the enlargement if it is not opened. The infection when it 
becomes generalized causes a fatal termination in most cases that 
are not treated. 




Fig. 1:5 — "Fi.sh knees." 

— Photo by Tlios. Millar, M. R. C. V. S. 

Native stock owners of some parts of Canada know this con- 
dition as "fish knees" because of the presence of the ruptured 
end of the extensor tendon which is found coiled in the cavity of 
the enlargements caused l)y the ruptured tendon. 

Local practitioners have treated the condition by incising the 
swollen mass and removing the part of tendon contained within 
such cavities. Treatment has not proved entirely satisfactory 
in the majority of instances, perhaps because of tardy inter- 
ference. 

In a colt's leg sent the author hy ^Iv. Tluimas ^lillar, ]\1. R. 
C. V. S., of Asquith. Saskatchewan, a careful dissection of the 
carpal region revealed the fact that in this case the ruptured 
extensor tendon was due to injury. The colt may have been 
trampled upon by its dam in such manner that the tendon was 
divided. No noticeable evidence of injury to tlie skin was to be 
seen on its outer surface, but on the fascial side a cyanotic con- 
gested area, which was situated immediately over the site of the 
ru]itured tendon, was very evident. 



146 



LAMENESS OP THE HORSE 



With the execution of a good surgical technic, the ruptured 
tendon might be sutured; the wound of the tendon sheath as 
well as that of the skin carefully united by means of gut sutures, 
the leg bandaged and immobilized with leather splints and re- 
covery follow in a reasonable percentage of cases so treated. 
These cases afford an opportunity for the perfection of practical 
means of treatment by those who frequently meet with this affec- 
tion. 

Rupture of the Flexor Tendons and Suspensory Ligament. 

Etiology and Occurrence. — Rupture of the flexor tendons or 
of the suspensory ligament is of rare occurrence. Frequently, 
these structures are divided as the result of wounds; but rup- 
ture, due to strain, is not frequent. 




Fig. 26 — Extreme dorsal flexion said to have resulted from an attack of 
distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4. 

In some cases in running horses, or in animals that are put 
to strenuous performances, such as are jumpers, rupture of ten- 
dons or of the suspensory ligament takes place. However, more 
frequently this follows certain debilitating diseases such as in- 
fluenza or local infectious inflammation of the parts which re- 
sults in degenerative changes and rupture follows. 

The non-elastic suspensory ligament receives some heavy strains 



LAMENESS IN THE FORE LEG 147 

during certain attitudes which are taken by horses in hurdle 
jumping as is explained in detail by IMontane and Bourdelle'^ 
under the description of this ligament. But in spite of the fre- 
quent and unusually heavy strains, which these structures re- 
ceive, complete rupture is not frequently seen. 

Symptomatology. — When the anatomy and function of the 
flexor tendons and suspensory ligament is thoroughly under- 
stood, recognition of rupture of either of these structures is 
easily recognized. When one considers that in rupture, a posi- 
tion directly opposite to that which is seen in contraction in 
either one of these structures, is assumed, a detailed description 
of each separate condition is needless repetition. 

However, it is pertinent to suggest that rupture of the deep 
flexor tendon (perforans) allows a turning up of the toe. 
Whether it be torn loose from its point of attachment or rup- 
tured at some point proximal thereto, the position is the same 
— heel flat on the ground, toe slightly raised and this raising 
of the toe varies in degree as the subject moves about. 

When the superficial flexor (perforatus) is ruptured there is 
no change in the position of the foot but the fetlock joint is 
slightly lowered. The pathognomonic symptom is the lax ten- 
don during weight bearing, which may be felt by palpation of 
the tendon along its course in the metacarpal region. 

With complete rupture of the suspensory ligament there oc- 
curs a marked dropping of the fetlock joint and an abnormal 
amount of weight is then thrown upon the superficial flexor ten- 
don (perforatus), causing it to be markedly tensed. This is 
readily recognized by palpation. By palpating the suspensory 
ligament from its proximal portion down to and beyond its 
bifurcation, while the affected member is supporting weight, it 
is possible to diagnose rupture of one of its branches. 

Prognosis and Treatment. — In rupture of the superficial 
flexor tendon (pei-foratus) because of its comparatively less im- 
portant function, i)rognosis is favoral)le and recovery takes place 
when proper treatment is put into practice. 



lAnatomie Regionale Des Animaux Domestique, page 695. 



148 LAMENESS OF THE HORSE 

With rui)ture of the deep tiexor tendon (perforans), especially 
when it occurs at or near its point of insertion and sometimes 
following disease, prognosis is unfavorable. 

Rupture of the suspensory ligament constitutes a condition 
which is, as a rule, hopeless, because of the impracticability of 
treating such cases. 

The salient feature which characterizes any practical attempt 
at treatment of ruptured tendons or other portions of the inhibi- 
tory apparatus of the fetlock region, is to retain the phalanges 
in their normal position for a sufficient length of time that the 
apprcximated ends of ruptured tendons or ligaments may unite. 
The length of time required for this to occur, together with the 




Fig. 27 — A good style of shoe for bracing the fetlock where tenotomy has 
been performed, or in case of traumatic division of the flexor tendons. An 
invention of Dr. G. H. Roberts. 

difficulties encountered in confining the affected extremities in 
suitable braces or supportive appliances, precludes all possibil- 
ity of this condition's being practically amenable to treatment 
when the deep flexor tendon (perforans) and suspensory liga- 
ment are simultaneously ruptured. It does not follow, even so, 
that recovery dees not succeed treatment in some of these un- 
favorable cases. 



LAMENESS IN THE FORE LEG 



149 



Affected .subjects are kept in slings as long as it seems neces- 
saiy — until they learn to get up without deranging the braces 
worn. 

Several styles of braces are in use and each has its objections ; 
nevertheless some sort of support to the affected member is neces- 
sary and steel braces which are connected with shoes are usually 
employed. 

The principal difficulty which attends the use of braces is 
pressure-necrosis of the skin which is caused by the constant 
and firm contact of the metal support. The practitioner's in- 
genuity is taxed in every case to contrive practical means of 
padding the exposed parts in order to prevent or minimize ne- 
crosis from pressure. This is attempted — with more or less suc- 
cess— by frequent changing of bandages and the local application 




Fig. 28— Showing- the lioberts Itiace in operation. 

of such agents as alcohol or witch hazel. Needless to say, the 
skin must be kept perfectly clean and the dressings free from 
all irritating substances. 

The fact that tendons or ligaments which are ruptured, do 
not regenerate as readily as in cases where traumatic or surgical 
(livisi( n occurs, must not be lost sight of, and prognosis is given 
in accordance. 



150 LAMENESS OP THE HORSE 

Thecitis and Bursitis in the Fetlock Region. 

Etiology and Occurrence. — Synovial distension of tendon 
sheaths and bursae in the region of the fetlock are caused by 
the same active agencies which produce this condition in other 
parts. The fetlock region is exposed to more frequent injury 
than is the carpus and as a consequence is more often affected. 
The same proportionate amount of irritation affects this part 
of the leg, owing to strains, as affect the carpus from a similar 
cause; and synovitis from this cause, is as frequent in one case 
as in the other. Therefore, it is a natural sequence that the 
tendon sheaths of the metacarpophalangeal region are frequently 
distended because of chronic synovitis and thecitis. These in- 
flammations are usually non-infective in character. 

The cul-de-sac of the capsular ligament of the fetlock joint 
which extends upward between the bifurcation of the suspensory 
ligament is the most frequently affected structure in this region. 
When distended, two spheroidal masses bulge laterally and an- 
terior to the flexor tendons in a characteristic manner. This 
condition is known among horsemen as "wind-gall" or "fet- 
lock-gall." 

The sheath of the flexor tendons, which begins about the mid- 
dle portion of the lower third of the metacarpus, and continues 
downward below the pastern joint is often distended. 

Excepting in cases of acute inflammation attending synovitis 
of these parts, no lameness marks its existence and in chronic 
cases of synovial distension the service of affected animals is not 
interfered with. These distensions constitute unsightly blemishes 
and they are treated chiefly for this reason. 

No difficulty is encountered in recognizing these conditions 
even where considerable organization of tissue overlying dis- 
tended thecae occurs. In such cases there may be only slight 
fluctuation of the enlargement, but if necessary, an aseptic ex- 
ploratory puncture may be made with a suitable needle or tro- 
car. 



LAMENESS IN THE FORE LEG 151 

Treatment. — Complete rest and the local application of cold 
packs are in order in acute synovitis when there is distension of 
tendon sheaths. In the fetlock region, because of the ease with 
which pressure may be employed, the parts should be kept 
snugly wrapped with cotton, and derby bandages are used to 
exert the desired amount of pressure over the affected region. 
The pressure-bandages should be employed as soon as all acute 
and painful inflammation has subsided ; and then they should be 
continued, day and night, for ten days or two weeks. The ban- 




Fig. 29 — DiHtfiision of thoca of the cxteiiscn- ui ihc digii u'Meiisor pedis). 

dages should be removed morning and night. After the skin 
of the leg has thoroughly dried off, an infriction of alcohol or 
distilled extract of hamamelis is given the parts and the cotton 
and bandages are readjusted. A good, even and firm pressure 
in such ca.ses is productive of satisfactory results. 

In chronic distensions of tendon sheaths synovia may be as- 
pirated and about five cubic centimeters of equal parts of tinc- 
ture of iodin and alcohol is injected into the cavity. This is not 
done, however, without usual aseptic precautions. If no marked 



152 LAMENESS OF THE HORSE 

swelling' results within forty-eight hours the entire fetlock re- 
gion is thoroughly vesicated and, as soon as the skin has recov- 
ered from the effects of the vesicant, pressure bandages may be 
employed. In these cases, subjects may be put into service after 
all swelling which the injection or the vesicant has produced 
has subsided. The pressure bandages are used at night or during 
the time that the horse is in its stall and they are not worn by 
the subject while at work. 

Where no marked swelling occurs within ten days, as the re- 
sult of the injection of iodin, the injection may be repeated and. 
if thought necessary, the quantity may be materially increased. 
If swelling does not occur it is indicative that no particular irri- 
tation has been caused. 

Some swelling is desirable and much swelling sometimes re- 
sults and persists for weeks. This is not in any way likely to 
cause permanent trouble; and if the teehnic of injection is skil- 
fully executed no infection will follow. 

By persistent and careful use of suitable elastic bandages, the 
support thus given the parts, together with the absorption of 
products of inflammation which constant pressure occasions, 
some chronic cases of synovial distension of tendon sheaths re- 
cover in two or three months and this without other treatment. 
Such good results are not to be expected in aged subjects, nor 
in horses having at the same time, chronic lymphangitis. 

Where bandages of pure rubber are employed great care is 
necessary, if one is not experienced in their use, lest necrosis 
result. Where bandages are uncomfoitabij^ tight the subject will 
manifest discomfort, and an attendant should observe the animal 
at intervals for a few hours (where there may be some doubt as 
to the degree of pressure which is exerted by elastic bandages) 
and readjustment made before any harm is done. 

Arthritis of the Fetlock Joint. 

Anatomy. — The anatomy of the metacarpophalangeal arti- 
culation is briefly reviewed on page 58 under the heading of 
" Anatomo-Physiological Review of Parts of the Foreleg." 

Etiology and Occurrence. — The chief causes of non-infective 



LAMENESS IN THE FORE LEG 



152 



arthritis of the fetlock joint are irritations from concussion and 
contusions due to interfering. The condition occurs in young 
animals that are over-driven in livery service or other similar 
exhausting work, where they become so weary that serious injury 
is done these parts by striking the pasterns with the feet — inter- 
fering. In these "leg- weary" animals, that are always kept 
shod with fairly heavy shoes, much direct injury is done at times 







^0^%.^ 



%^ 




'^ 



Fig-. 30 — Rarefying o.steitis whereii> articular cartilage was destroyed in a 
case of arthritis of fetlock joint. 

by concussion due to self-intiicted blovAs. In older animals, 
where there exists similar conditions, with respect to their being 
worn from fatigue and. in addition, periarticular inflammatory 
organizations, arthritis is not of uncommon occurrence. 

Symptomatology. — In true arthritis there exists a very pain- 
ful affection Avhich is characterized by manifestations of distress. 
The subject may keep the extremity moving about — where pain 
is great — suspended and swinging. There is swelling which is 
more or less hot to the touch and compression of the parts with 
the fingers increases pain. Lameness is always iironounced and 
no weight is supported with the affected member in very acute 
and generalized arthritic inflammations. There occurs the usual 



154 LAMENESS OF THE HORSE 

facial manifestations of pain — the tense condition of the facial 
muscles and the fixed eye and nostril are in evidence 

In cases Avhere there exists a synovitis or Avhere a very limited 
portion of the articulation is involved, a somewhat different clin- 
ical picture is presented. Then, the disturbance causes less dis- 
tress; local swelling and evidence of supersensitiveuess are not 
so pronounced and lameness is not intense, though weight-bearing 
is painful. 

Prognosis. — There is a constant difference in the degree of 
pain manifested, as well as the other symptoms of inflammation, 
between true arthritis, which involves much of the joint, and 
synovitis; or synovitis plus a small circumscribed area of joint 
involvement. This difference is present in all joint affections 
of the extremities and, in passing, it is well to say that infection 
usually increases every manifestation of pain. Infection occasions 
more pronounced local symptoms of inflammation and, because 
of the rapid progress of necrotic destruction of cartilage, the 
course of the affection is usually rapid; ankylosis is a frequent 
result and loss of the subject is often inevitable. However, in 
non-infective arthritis of the fetlock joint, prognosis is favor- 
able. 

Treatment. — The same general principles which are employed 
in arthritis of other joints are used here. Eest and comfort for 
the patient is sought in every available manner. If the subject 
remains standing too long, the sling should be used and a well- 
bedded box-stall will contribute much to the comfort of the 
patient. 

Pain and acute inflammation is diminished or controlled, if 
possible, by using ice-cold packs. In nervous, well-bred animals 
analgesic agents may be employed; or small doses of morphin 
sulphate — one to two grains — given at intervals of three hours 
during the first stages of the affection is very beneficial. This 
is especially indicated in infectious arthritis. 

As inflammation subsides, hot applications are used and finally 
counter irritants are employed. Their selection is a matter of 
choice with the practitioner. The object sought is the same 
with every practitioner and while methods employed vary, re- 



LAMENESS IN THE FORE LEG 155 

suits are uot markedly different except in so far as the degree 
of counter irritation which is produced varies in given cases. 
Where a great degree of counter irritation is thought necessary, 
line-firing with the actual cautery is the remedy par excellence. 

After-care. — In the course of three or four weeks su])jects 
may be allowed the run of a paddock and, after a complete rest 
of six weeks at pasture, they may be returned to work with care, 
if the work is not of a nature to occasion concussion or other 
manner of irritation to the articulation. 

Neurectomy is not indicated even though there is a recurrence 
of lameness, unless the lameness is not pronounced and inflamma- 
tion is periarticular and no osseous enlargements mechanically 
interfere with function of the joint. There are few cases then, 
where neurectomy is materially helpful. 

Ossification of the Cartilages of the Third Phalanx. 
(Ossification of the Lateral Cartilages.) 

Anatomy and Function of the Cartilages. — Surmounting each 
wing of the distal phalanx (os pedis) is the irregularly-quad- 
rangular cartilage. The superior border of this cartilage is thin, 
generally convex, and perforated for vessels to pass to the frog ; 
the inferior border is attached to the wing of the third phalanx 
and posteriorly, it is reflected inward and is continuous with 
the inferior surface of the sensitive frog. The anterior border 
which is directed obliquely downward and backward becomes 
blended with the anterior lateral ligament of the coffin joint. 
The fibrous expansion of the anterior digital extensor (extensor 
pedis) is united to the anterior borders of the lateral cartilages. 

According to Smith^ : These structures form an elastic wall 
to the sensitive foot, and attachment to the vascular laminae; 
they also admit of increase in width occurring at the posterior 
part of the foot without destroying the union of the two set of 
leaves. Further, by their connection Avith the vascular system 
of the foot, their elastic movements materially assist the circu- 
lation. The primary use of the lateral cartilages is to render 
the internal foot elastic, and admit of its change in shape which 
occurs under the influence of the weiglit of the body. The 

^Manual of Veterinary Physiology, by Major-General F. Smith, C. B., 
C. M. G., page 678. 



156 LAMENESS OF THE HORSE 

alteration in the shape of the foot is brought about by pressure 
on the pad, which widens and in consequence presses on the bars. 
The pressure received by the pad is also transmitted to the plan- 
tar cushion, which likewise flattens and spreads under pressure. 
Both of these factors force the cartilages slightly outwards. 
When the posterior wall recoils the cartilages are carried back 
to their original position. Should the elastic cartilage under 
pathological conditions become converted into bone, its functions 
are destroyed, and lameness may occur. 

Etiology and Occurrence. — The causes of ossification of these 
cartilages are several. No doubt there exists a predisposition 
to this condition for it is of such frequent occurrence in heavy 



5'" 



'A 



h*4 






Fig. 31 — Ringbone and sidebone. 

draft types of horses. Concussion plays an important role and, 
according to Holler's^ theory, which is sound, high heel calks 
prevent the frog from contacting the gi'ound, and as weight is 
placed upon the foot "the lateral cartilages are subjected to a 
continuous inward and downward dragging strain." 

The condition affects the cartilages of the fore feet more fre- 
quently than those of the hind and the outer cartilage is more 
often ossified than is the inner. This fact may be accounted for 
by its more exposed position; it is also frequently injured by 



iMoller's Regional Veterinary Surgery, by Dollar, page 630. 



LAMENESS IN THE FORE LEG 157 

being trampled upon and otherwise contused or cut, as in lacer- 
ated wounds of the quarter, 

Symptomiatology. — Ossification of the cartilages is known by 
grasping the free borders with the fingers and attempting their 
flexion ; the rigid inflexible ossified cartilage is thus easily recog- 
nized. 

Lameness during weight-bearing occurs in the majority of 
cases at some time. Much depends on the conformation of the 
foot and whether the involvement affects one or both cartilages 
as to the degree and duration of lameness which marks this 
affection. In narrow and contracted heels it is reasonable to 
expect more lameness than in well formed feet. Where only 
one cartilage is ossified, the other being flexible, there is less in- 
convenience experienced by the subject during weight-bearing, 
because of the expansion of the heel which the one normal carti- 
lage allows. 

Treatment. — There is little if anything to be done in case the 
cartilage has become ossified except to shoe M'ithout high calks 
but preferably with rubber pads. The hoof should be kept 
moist; the wall at the quarter may be rasped thin and kept 
anointed. Firing is of no practical benefit in these cases, and 
it is doubtful if vesication is helpful excepting where only a part 
of the cartilage is ossified. . 

Subjects which continue somewhat lame, because of complete 
ossification of both cartilages, are best put to slow Avork on soft 
ground and not driven on pavements. 

Navicular Disease. 

This more or less ambiguous term has been applied to various 
disea.ses affecting the structures Avhich make up the cofiin joint. 
We consider this name to be applicable to inflammatory involve- 
ment of the third sesamoid (navicular bone), the deep flexor 
tendon (perforans) and the bursa podotroehlearis or navicular 
bursa. 

Etiology and Occurrence.— Tn 18fi4 Thomas Greaves^ Avrote 
on the subject of navicular disease as follows: ''The opinion I 

^Edinburgh Veterinary Review, Vol. VI, page 616 



158 LAMENESS OF THE HORSE 

entertain upon the subject of navicular disease is, that in by 
far the greater majority (if not all) of these cases there exists 
in the animal affected a congenital tendency or predisposition, 
that, generally speaking, it is the high stepper, the good goer, 
that becomes the victim to this disease ; and it is a fact well at- 
tested, that it as frequently develops itself in the feet with wide 
frogs, bulbous heels, shallow heels, spread flatfish feet, as in the 
narrow upright feet. ... I have known foals, born from de- 
fective parents, in which this condition was so strongly devel- 
oped, that all men Avould at once pronounce them affected with 
navicular disease, and such lameness was permanent." 

Often both fore feet are affected and this would point toward 
its being a disease wherein either conformation or congenital 
tendencies exists. It is rare that hind feet are involved. 

There are many theories regarding the possible exciting causes 
of navicular disease and, Avhen one has carefully considered the 
explanations as offered by Peters, IMoller, Branell, Schrader and 
others, he may conclude that navicular disease is a non-infectu- 
ous inflammatory affection of the third sesamoid (navicular) 
bone, deep flexor tendon (perforans) and adjoining structures. 
Whether it originates in the flexor tendon or whether the bone 
is the original part affected, the disease is frequently met, and 
of all possible causes, jars and irritation incident to concussion 
of travel, are probably the principal causative agents. 

Symptomatology. — Lameness is the primary indicator and a 
constant symptom which attends navicular disease wherever 
much structural change affects the infirm parts. As the degree 
of intensity or extent varies, so is there a dissimilarity in the 
character of the impediment. Incipient cases of bilateral in- 
volvement are more difficult to diagnose than are unilateral af- 
fections, particularly when lameness is not marked. There is 
manifested a supporting-leg-lameness which varies as to degree 
in the same subject at different times. This may be noticed dur- 
ing the same trip in an animal that is being driven There is 
a tendency for the subject to stumble and, of course, where the 
affection is bilateral, there is a stilted gait owing to shortened 
strides. 



LAMENESS IN THE FORE LEG 159 

At rest the lame animal usually points with the affected mem- 
ber. Because of the fact that the distance is lessened between 
the origin and insertion of the deep flexor tendon (perforans) 
by this attitude, one may readily understand the reason for the 
position assumed by the subject. Pressure on the navicular bone 
IS diminished and tension on the flexor tendon is relieved by 
even slight volar flexion. 

In acute inflammatory affections abnormal heat may be de- 
tected in the region of the heel. By exerting tension on the 
flc^xor tendon, l)y means of passive dorsal flexion of the member, 
evidence of hyperesthesia may be detected. With the hoof test- 




Fi^^ 32— "Pointing-— the position assumed by horse havirg unilateral navic- 



ular disease 



ers one may determine supersensitivenss in most instances. There 
occurs more or less contraction of the hoof in navicular disease, 
but this is not to be taken as a cause of the affection, but rather 
a sequence. 

In some cases of unilateral navicular disease there is a marked 
contrast in size between the sound and unsound foot. HowcAer, 
one must not be misguided in this particular, for in some pairs 
of sound feet there exists considerable difference in size. Finally, 
by a change from the normal position of the foot to one in whit'li 
the heel is somewhat elevated (as may 1)e obtained by shoein- 
with high heel calks), relief is evideut, and in the opposite 



160 LAMENESS OP THE HORSE 

position, the condition is aggravated. This experiment may be 
used for diagnostic purposes. 

Treatment. — "When the anatomy of the diseased parts is 
taken into consideration, and an analysis of the lesions which 
occur in cases where considerable structural change is occasioned 
by this affection, it is obvious that recovery is impossible. Only 
in cases where the inflammation is promptly checked before 
damage has been done the navicular bone or the flexor tendon, 
is permanent recovery possible. The disease is not frequently 
treated during this stage, however, and in the majority of in- 
stances the condition becomes chronic. 

As soon as a diagnosis is made the shoes must be removed, the 
toe shortened with the hoof pincers and rasp and the subject is 
put in a well bedded box-stall. If the animal is very lame and 
the inflammation is acute, ice-cold packs should be applied to 
the feet. As soon as acute inflammation has subsided the foot 
may be so pared that all excess of sole and frog is removed with- 
out lowering the heels, and the animal may be blistered about 
the coronet region. The subject may be shod later, with heel 
calks that raise the heel moderately and a protracted period of 
rest should be enforced. 

In cases where no acute inflammatory condition exists, neurec- 
tomy is beneficial. One must discriminate, however, between 
favorable and unfavorable subjects. This is not a last resort 
expedient to be employed in cases where extensive lesions of the 
navicular structures exists. With proper shoeing, and by put- 
ting the subject at suitable work, where concussion of fast travel 
on hard roads is not necessary, the best results are 6btainable. 

Laminitls. 

This disease is primarily a non-infective inflammation of the 
sensitive laminae which very frequently affects the front feet. 
Often all four feet are affected, less frequently one foot (when 
its fellow is unable to sustain weight) and rarely the hind feet 
alone. 

Occurrence. — Probably a greater number of cases of laminitis 
occur in localities where horses that are worked on heavy trans- 



LAMENESS IN THE FORE LEG 161 

fer wagons are, when in a state of perspiration, allowed to stand 
exposed to sudden lowering of temperature and to stand in a 
cool or cold shower of rain such as occurs near the coast of the 
Great Lakes or the ocean in some parts of this country. 

This disease occurs in connection with digestive disorders of 
various kinds and, because of the frequent association of the 
two conditions, the common term "founder" has long been em- 
ployed to designate laminitis. In cases of "over-loading," par- 
ticularly when a large quantity of wheat has been eaten by 
animals that are unaccustomed to this diet, laminitis almost con- 
stantly results. 

Large draughts of cold water, when drunk by animals that 
are overheated is often followed by laminitis. Concussion, such 
as attends hard driving, especially in unshod horses or on rough 
and hard roads, is often succeeded by this affection. Likewise, as 
has been stated, injury such as is occasioned by long continued 
standing on the same foot is followed by laminitis. Some horses 
that are frequently shod, suffer from this affection a few hours 
after shoes have been reset. Dr. Chas. R. Treadway of Kansas 
City reports the rather frequent occurrence of such conditions 
in horses that are in the fire department service in his city. 

Age in no way influences the occurrence of laminitis and the 
general condition of an animal with regard to its vigor or state 
of flesh has no apparent influence toward predisposing horses to 
this ailment. 

Etiology and Classification. — As it is with some other dis- 
eases, one may unprofitably theorize on cause and readily enu- 
merate many conditions which are apparently contributory 
toward producing the affection. Causes may well be grouped, 
however, and a more definite understanding of laminitis is pos- 
sible as a result. Such collocation would include conditions 
which directly or indirectly affect the digestion, such as puer- 
peral laminitis, drinking of large quantities of cold water and 
exposure to cold and rain when the body is warm. All of these 
various conditions might be said to affect the vaso-coustrictor 
nerves in such manner that the natural tendency (because of the 
peculiar structure of the sensitive laminae and their mode of 



162 LAMENESS OF THE HORSE 

attachment to the non-sensitive wall) which solipeds have for 
this affection is indirectly due to this one cause — vaso-constric- 
tion. According to Dr. D. M. Campbell, the effect of toxic ma- 
terials, which may be absorbed from the digestive tract or the 
uterus in parturient females, upon the vaso-constrictor nerves, 
is such that a passive congestion of the sensitive laminae occurs 
and laminitis is the result. He believes that even the chilling 
of the surface of the body when very warm, by a cold rain, con- 
stitutes a condition wherein the effect upon the vaso-constrictors 
is the same. 

This grouping does not include the effect of direct injuries of 
any and all kinds to which the feet are subjected such as : 
Concussion in fast road work, injuries occasioned by tight or 
ill fitting shoes, contusions of any kind resulting in non-infec- 
tious inflammation of the sensitive laminae, as well as the causes 
which produce laminitis where weight is borne by one foot when 
its fellow is out of function. 

A classification which is practical is that of acute and chronic 
laminitis. To the practicing veterinarian it is this manner 
of consideration that is essential in the handling of these cases. 

Symptomatology. — In the acute attack the condition is so 
well described by Dr. R. C. Moore^ that we quote him in part as 
follows : 

The acute form is generally ushered in very suddenly. Often 
a horse that is perfectly free from symptoms of the disease is 
found a few hours later so stiff and sore that he will scarcely 
move. They stand like they were riveted to the ground. If 
forced to move the evidence of pain subsides to some extent after 
they have gone a short distance, to return more severe than ever 
after they have been allowed to stand for a short time. If the 
disease is confined to the two front feet, the hind feet are placed 
well under the center of the body to support the weight and 
the front ones are advanced in front of a perpendicular line so 
as to lessen the weight they must bear. If they are made to 
move, the same position of the feet is maintained. If made to 
turn in a small circle, they do so by using the hind feet as a 
pivot, bringing the front parts around by placing as little weight 
on them as possible. 

Placing the hind feet so far under the body, arches the back 

'Equine Laminitis or Pododermatitis, by R. C. Moore, D. V. S., American 
Journal of Veterinary Medicine, Vol. XI, page 284. 



LAMENESS IN THE FORE LEG 163 

and often leads to errors in diagnosis, the condition sometimes 
l;eing taken for diseases of the k)ins or kidneys. 

If all four feet are involved, the animal stands in the usual 
position assumed in health, but if urged to move, the least effort 
to do so usually brings on chronic spasms of the entire body. In 
very severe cases, a slight touch of the hand will develop the 
spasms. At times they are so severe, and have such short inter- 
missions, that the disease has been mistaken for tetanus. How- 
ever, the clonic nature of the spasm should prevent such an 
error. If th^y are lying down, it is difficult to get them to arise, 
and if they do so, they show marked symptoms of pain for some 
time after rising. 

If the disease is confined to the hind feet, they are placed 
well forward to relieve the strain on the toe caused by the down- 
ward pull of the perforans (deep flexor) tendon, but in place of 
the front feet being kept in front of a perpendicular line, as they 
are when the disease is confined to the front ones, they are placed 
far back under the body, so they will carry the maximum share 
of the body weight of which they are capable. The position of 
the feet is of great importance and offers symptoms that should 
not be overlooked. 

Wlien the subject is caused to walk, symptoms of excruciating 
pain are manifested in all acute cases of laminitis. In some cases 
where all four feet are affected, no reasonable amount of per- 
suasion will cause the suffering animal to move from its tracks. 

There is acceleration of the rate of heart action ; the pulse 
is full and in some cases, bounding. As the affection progresses 
the pulse becomes rather weak and irregular. The character of 
the pulse in the region of the extremity is a reliable indicator; 
but one has to learn to make necessary discrimination because 
of the condition of the parts, as in some cases of lymphangitis 
or where the skin is abnormally thick. The characteristic throb- 
bing pulse is, however, easily recognized in most cases. Tem- 
l>erature is varial)le, though usually elevated from one to four 
degrees above noi-mal. This symptom varies with the type and 
stage of the affection. In a subject that has been down, unable 
to rise for several days, where there is a suppurative and slough- 
ing condition of the laminae, the temperature is high. Whereas, 
in some other and less destructive cases there may be little 
thermic disturbance after the first few hours have lapsed. 

A constant symjitom in liilatcral afftM'tions of acute laminitis 



164 LAMENESS OP THE HORSE 

is the difficulty with which the subject supports weight with 
one foot. It is this which causes the victim to stand as if 
"rooted to the ground" when all four feet are involved. If one 
attempts to take up one foot, thus causing the subject to stand 
on the other, there is much resistance and in many cases the 
animal refuses to give the foot. 

When we consider that the sensitive parts of the foot are 
encased by a horny, unyielding box and that, when the laminae 
are congested, a great pressure is brought to bear upon the sensi- 
tive structures, it is easy to understand why the condition is so 
painful. 

Chronic laminitis is a sequel of acute inflammation of the sensi- 
tive laminae. It varies as to intensity and the exact manner 
of its manifestation depends upon preexisting disturbances. 

In some mild cases of laminitis there are recurrent attacks 
wherein no particular structural change exists, and diagnosis 
is established chiefly by noting the character of the pulse at the 
bifurcation of the large metacarpal (or metatarsal) artery just 
above the fetlock. The same manifestation of pain is present 
when weight is supported by one foot, though in a lesser degree. 
There is less local heat to be detected by palpation than in 
the acute cases. 

Chronic laminitis as it occurs following acute attacks which 
have resulted in structural changes of the foot, present the same 
symptoms just described and, in addition, the peculiar altera- 
tions in structure exist. When, owing to acute inflammation of 
the sensitive laminae, there has resulted necrosis of this sensitive 
tissue together with infiltration between the anterior surface of 
the distal phalanx (os pedis) and the contacting hoof, the lower 
portion of the distal phalanx is turned downward and backward 
(rotated upon its transverse axis). Because of the traction 
which is exerted by the deep flexor tendon (perforans), as it 
attaches to the solar surface of the distal phalanx, this rotation 
is facilitated. With hyperplasia of lamina, at the anterior por- 
tion of the distal phalanx, there results a thick "white line." 
Rotation of the distal phalanx necessitates a descent of its apical 
portion and there occurs a "dropped sole." 



LAMENESS IN THE FORE LEG 



165 



In time, partly because of excessive wear of hoof at the heel, 
owing to an altered condition in the normal antagonistic rela- 
tion between the flexor and extensor tendons, the toe makes an 
excessive growth, and the concavity of the anterior line is ac- 
centuated owing to this abnormal length of hoof. The hoof, 
because of recurrent inflammatory attacks, is corrugated — eleva- 
tions of horn in parallel rings are usually present. 

Animals that are so affected in traveling strike the heel first 




Fig. 33 — The hoof in chronic laminitis. Note the concavity. Thi.s animal 
was serviceable for any work that could be performed at a walk. 



and the toe is later contacted with the ground surface. Rotation 
of the distal phalanx upon its transverse axis produces a con- 
dition, with respect to this peculiar impediment, that is equiva- 
lent to added and excessive length of the deep flexor tendon. 

Where there occurs suppuration, by careful inspection of the 
coronary region, one may early recognize detachment of hoof. 
In such eases animals remain recumbent and, while the condi- 
tion is not so painful at this stage, the practitioner must not 
overlook the real state of affairs. History, if obtainable, will 
be a helpful guide in such cases. Separation of hoof occurs as 



166 



LAMENESS OF THE HORSE 



a rule in from four to ten days after the initial attack of acute 
laminitis. Needless to say these cases are hopeless, when the 
economic phase of handling subjects is considered. 

Treatment. — Much depends upon the concomitant disturb- 
ances (or causes if one is justified in referring to them as such) 
as to the manner i)i which laminitis is to be treated. In all cases 
where digestive disturbances exist, the prompt unloading of the 




Fig. 34 — Showing tlie effects of 
"Veterinary Surgical Operations." 



laminitis. By permission, from Merillat's 



contents of the alimentary canal is certainly indicated. D. M. 
CampbelP in a discussion of laminitis has the following to say 
regarding the treatment of such cases : 

Because superpurgation may be followed by laminitis, the ad- 
visability of using the active hypodermic cathartics is questioned. 
Neither arecolin nor eserin can cause superpurgation. The action 
of the former does not continue longer than an hour after ad- 
ministration and of the latter not more than eight hours. The 
action of either is mild after the first few minutes. 

I do not think that anyone has recommended either arecolin 
or eserin where there is severe purgation. Where the intestinal 
canal is fairly well emptied and its contents fluid, I should be 
inclined to rely upon intestinal antiseptics to hold in check harm- 
ful bacterial growth. 

^American Journal of Veterinary Medicine, A'ol. XI, page 31S. 



LAMENESS IN THE FORE LEG 167 

The use of alum in the treatment of laminitis is held to be with 
out reason other than the empirical one that it is beneficial. If 
laminitis is due chietiy to an autointoxication, good and sufficient 
reason for the administration of alum can be shown based upon 
Its known physiological action. It is the most powerful in- 
testinal astringent that I know of and has the fewest disad- 
vantages. I have not noted constipation following its use nor 
diarrhea, nor a stopping of peristalsis, nor indigestion, and in 
any case its action lasts at most only a few hours, and if it did 
all these, it could not much matter. Quitman says, that it con- 
stricts the capillaries. If this is true, a thing of which I am not 
certain, is it not reasonable to suppose that as with other vaso- 
constrictors, e. g., digitalis, there is a selective action on the part 
of the capillaries (not of the drug) and those that need it most, 
1. e., those of the affected feet in laminitis, are constricted most^ 
All body cells exert this selective action in the assimilation of 
food, the tissue needing most any particular kind of food cir- 
culating in the blood, gets it. 

Our first consideration in laminitis should be to remove the 
cause— to stop the absorption of the toxin in' the intestinal tract 
that IS producing the condition. This we accomplish bv partiallv 
unloading it by the use of the active hypodermic cath'artics and 
stopping absorption by the surest and most harmless of intestinal 
astringents. Whether the astonishingly prompt and certain 
action of ahun in this case is due whollv to its astringent action 
or whether alum combines with the harmful bacterial products 
chemically and forms an innocuous combination, I can only sur- 
mise, and It is unimportant. At any rate, Avhen alum is ad- 
ministered, the onslaught of the disease is promptlv stopped Ir- 
reparable damage may already have been done if the case is a 
neglected one, but whether administered early or late in acute 
attacks, the progress of the disease is stopped "immediately. 

The same authority may be profital)ly quoted in the "matter 
of handling all cases wherein the revulsive effect of agents which 
diminish vascular tension are chiefly indicated or necessary as 
adjiivants. In this connection, Camplx'll says: 

The early and vigorous administration of aconitin in laminitis 
to Its full physiological effect, is more logical. Assuming that 
laminitis is due to absorption of harmful products from the 
intestinal tract permitted through the deranged functionincr of 
the organs of digestion, or assuming that it is due to an exten- 
sion of the inflammation from the mucosa to the sensitive lamina, 
or that it is a reflex from a sudden chilling of the skin, we have 
in any of these conditions a disturbed circulation, and aconitin 



168 



LAMENESS OF THE HORSE 



is the first and foremost of circulation ''equalizers." Further- 
more, in laminitis there is an elevation of the temperature, an 
almost invariable indication for aconitin. A speedy return of 
the temperature to normal, a very marked diminution of the 
pain and improved conditions generally, appear coincident Avith 
the symptoms of full physiological effect of aconitin when given 




Fig, 



Inferior (convex) surface of Cochran shoe. 



in cases of laminitis, which constitutes assuredly an important 
part of its treatment. 

Where lameness is not great as in cases wherein no marked 
structural change of the foot has occurred, proper shoeing is very 
beneficial. By keeping the heels as low as possible and shoeing 
without heel calks a more comfortable position is made possible. 
Thin rubber pads which do not elevate the heel are of service in 
diminishing concussion. 



LAMENESS IN THE FORE LEG 



169 



Dr. David W. Cochran of New York City has attained unusual 
success in cases of chronic laminitis with dropped sole by the use 
of a specially designed shoe. 

Cochran claims that, not only are horses with dropped soles 
that would otherwise have to be put off the streets enabled to do 




Fig. 36 — Superior surface, showing concavity or bowl, as formed by the toe 
and branches of the shoe, as designed by Dr. David W. Cochran. 

a fair amount of work by means of this shoe, but that continually 
wearing it, meanwhile keeping the convexity of 'the front of the 
hoof rasped thin, in time brings about a marked improvement, 
and that after some months or years of use the animals are able to 
work with ordinary rubber-pad shoes, provided they are ar- 
ranged to facilitate breaking over. 
From having been successfully used on some race horses of 



170 LAMENESS OF THE HORSE 

high value, the Cochran shoe has attained considerable notoriety 
and is being used by a number of practitioners. A disadvantage, 
however, arises from the fact that few horseslioers other than 
Doctor Cochran seem able to make the shoe, the peculiar shape 
of which offers considerable difficulty in forging Concerning 
the application of the shoe Cochran^ says : 

* ' The most important primary procedure is the preparation of 
the foot to receive the shoe. All excess of growth must be 
removed from the anterior face of the hoof. The outer face 
must be reduced at the toe (not shortened), but rasped down 
thin for the lighter the top of the foot is, the more chance the 
sole and coffin bone will have of resuming their former normal 
position. The pressure of the wall at the toe upon the exudate 
between wall and coffin bone, tends to force the coffin bone and 
sole out of their normal position. Leave the sole alone. You can 
lower the excess of growth at the heels. 

"There are many designs of shoes to relieve this condition. 
A great deal de.pends on the judgment of the shoer to meet the 
conditions presented, depending on the degree of the convexity 
and strength of the sole. In some cases we use a shoe that admits 
of a large amount of sole room. Again, we shoe with a shoe of 
wide cover. In other cases a shoe wnth even pressure over the 
whole sole. In some cases a high, narrow shoe, resting only on 
the wall, or the ordinary plain shoe with side calks welded close 
to the outside edge and the shoe dished well from these as a 
foundation. Then we have the air cushion pad designed after 
the model of the bowl shoe." 

In cases when slight and persistent lameness interferes suffi- 
ciently to prevent using an animal at any sort of work on hard 
roads, median neurectomy will relieve all lameness in most in- 
stances. This is a safe operation, moreover, in that no bad after 
effects are to be feared, even though lameness were to continue. 

Calk Wounds. (Paronychia.) 

Etiology and Occurrence. — Injuries of various kinds are in- 
flicted upon the coronary region but usually they are due to the 
foot being trampled upon. When the foot that inflicts the in- 
jury happens to be unshod, a contusion of the injured member 
is occasioned, but in the majority of instances, wounds that de- 
mand attention are the result of shoe calks which have pene- 

^The Shoeing of a Dropped fJole Foot by Dr. David W. Cochran. New 
York City, The Horse Sheers Journal, March, 1015. 



LAMENESS IN THE FORE LEG 171 

trated the tissues in the region of the coronary baud. Often 
calk wounds are self-inflicted. When animals are excited and in 
turning croAvd one another, they often perform dancing move- 
ments which frequently result in deep calk wounds of the coro- 
net. Some horses have a habit of resting the heel of one hind 
foot upon the anterior coronary region of the other. While 
sleeping in this position, if they are suddenly awakened, the 
weight is abruptly shifted to the uppermost foot and the one un- 
derneath is (because of the pain attending its being wounded) 
quickly drawn out from under its fellow. In this way deep cuts 
may divide the coronary band and inflict extensive injury to the 
sensitive lamina as well. 

An infectious type of coronary inflammation occurs in some 
localities during the Mdnter months, wherein the condition is 
enzootic. 

Symptomatology. — Depending upon the manner in which 
the injui-y has been produced, the appearance of the wound 
varies and lilvcwise lameness is moi-e or less pronounced. If the 
tissues are not divided and the wound is chiefly of the subsur- 
face structures, there will not immediately occur pronounced 
local evidence of the existence of injury; but as soon as the lame 
animal is made to move, the peculiar character of the impedi- 
ment (supporting-leg lameness with the aifected foot kept well 
in advance of its normal position) directs attention to the ex- 
tremity and all of the symptoms of acute inflammati(m are dis- 
covered. 

AVhere a M'ound is inflicted Avhieh divides, in some manner, 
the surface structures (skin, coronary band, or the hoof wall) 
one's attention is at once called to the existence of the wound. 

Because of the fact that there is every facility for the pro- 
duction of a sub-coronary and podophylous infection, these 
wounds should receive prompt attention. In some instances, 
the pastern joint is opened by calk wounds and then, of course, 
an infectious arthritis succeeds the injur}'. 

Treatniient. — In all contused wounds of the coronary region 
the i)arts need thorough cleansing; the hair, if long is clipped 
and a cataplasm is applied. Or preferably, an iodin-glycerin 
combination of one part of iodin to four parts of glycerin is 



172 LAMENESS OF THE HORSE 

poured on a layer of cotton, and this is confined in contact with 
the inflamed parts by means of a bandage. 

Where normal resistance to infection obtains, the subject usu- 
ally suffers no suppurative disturbance when the surface struc- 
tures are not broken; and daily applications of the antiseptic 
lotion above referred to stimulates complete resolution. This 
may be expected in from four to ten days depending upon the 
extent of the injury. 

If a calk wound has been inflicted, the adjoining surface struc- 
tures are freed of hair and the parts cleansed in the usual man- 
ner, (which in wounds recently inflicted, should be done without 
employing quantities of water) and after painting the wound 
surface with tincture of iodin and saturating its depths with the 
same agent, the wound is cleansed, if it contains filth, by means 
of a small curette. By using a small and sharp curette, one is 
enabled to cleanse the average wound quickly and almost pain- 
lessly. 

In such cases, equal parts of tincture of iodin and glycerin 
are employed. The wound is filled with this preparation and a 
quantity of it is poured upon a suitable piece of aseptic gauze 
or cotton and this is contacted with the wound. The extremity 
is carefully bandaged and this dressing is left in position for 
forty-eight hours unless there occurs, in the meanwhile, evidence 
of profuse suppuration — which is unusual. 

One is to be guided as to the progress made by the degree 
of lameness present. If little or no lameness develops, it is 
reasonable to expect that infection has been checked; that the 
wound is dry and redressing every second day is sufficiently fre- 
quent. 

Where cases progress favorably, recovery (unless infectious 
arthritis results) should occur in from ten days to three weeks. 
Where extensive sub-coronary fistulae result, either from lack 
■of prompt or proper attention, the condition is then one requir- 
ing a radical operation to establish drainage and to disinfect 
if possible, the suppurating tissues. 

Corns. 

Etiology and Occurrence. — In horses, because of a tendency 
toward contraction of the heel in some subjects, together with 



LAMENESS IN THE FORE LEG 173 

work on hard roads and pavements, where the feet become dry 
and brittle, and because of neglect of the matter of shoeing, 
this affection is of frequent occurrence. Unshod liorses are rarely 
affected. If conformation is faulty and too much weight is 
borne on the inner or the outer quarter, and the hoof wall at 
the quarter tends to turn inward, corns are usually present. 
They occur more frequently on the inner quarters of the front 
feet, though the outer quarters are occasionally also affected and 
in rare instances corns are found at the toes. They do not often 
affect the hind feet. 

As soon as injury by pressure, such as is supposed to cause 
the formation of corns, is brought to bear on the sensitive sole, 
an extravasation of blood occurs. In time when the cause re- 
mains active, this discoloration is evident in the substance of the 
insensitive sole and consists in a red or yellowish spot which 
varies in size — this is ordinarily termed dry corn. 

In some cases where infection of this extravasation of blood 
and serum occurs, instead of desiccation and discoloration of the 
insensitive parts, there is, in time, manifested a circumscribed 
area of destruction of the insensitive sole and the abscess may, 
where no provision for drainage exists, burrow between sensitive 
and insensitive laminae and perforate the tissues at the coronet. 
If the suppurative material discharges readily by Avay of the 
sole, no disturbance of the heel or quarters occurs above the 
hoof. 

Symptomatology. — A supporting-leg-lameness characterizes 
this condition ; and this lameness in most instances varies in de- 
gree with the amount of distress which is occasioned by pressure 
upon the inflamed parts. By an examination of the sole after 
having removed all dirt, and exposed the horny sole to view, 
no difficulty is encountered in locating the cause of the trouble. 

Treatment. — Before suppuration has taken place and in tlie 
cases where suppuration does not occur, the horse-shoer's method 
of paring out the diseased tissue affords a means of temporary 
relief; but unless frequently done, in many cases, lameness re- 
sults within about three weeks after such treatment has been 
given. In other instances temporary relief is not to be gotten 



174 LAMENESS OF THE HORSE 

in this manner for any great length of time or until a more 
rational mode of treatment becomes necessary so that the sub- 
ject may experience a cessation of the inconvenience or distress. 

The general plan which meets with the approval of most prac- 
titioners consists in careful leveling of the foot and removing 
enough of the wall and sole at the quarters to make possible frog 
pressure by means of a bar shoe. With frog pressure, expansion 
of the heel follows in time, and permanent relief is obtainable 
in this manner. Thinning the wall of the quarter is advocated 
by many practitioners and is undoubtedly beneficial in chronic 
cases where marked contraction has taken place. The wall must 
be thinned with a rasp until it is readily flexible by compressing 
with the thumbs. 

There are instances, however, where corns and contraction of 
the heel have existed so long that they do not yield to treat- 
ment. Such cases are found in old light-harness or saddle-horses 
that have been more or less lame for years and where there exists 
marked contraction of the heels, rough hoof walls, and hard and 
atrophied frogs. 

Suppurating corns require surgical attention in the way of 
removal of the purulent necrotic mass and making provision 
for drainage. Dry dressings, such as equal parts of zinc sulphate 
and boric acid, may be employed to pack the cavity. After the 
infectious condition has been controlled, and the wound is dry, 
the same plan of treatment is indicated that is employed in the 
non-suppurating corn. Ample time is allowed, however, for the 
surgically invaded tissues to granulate and, if the subject is to 
be put in service, a leather pad, under which there has been 
packed oakum and tar, affords good protection. 

Quitlor. 

This name is employed to designate an infectious inflamma- 
tion of the lateral cartilage and adjoining structures. The 
disease is characterized by a slowly progressive necrosis and by 
a destruction of more or less of the cartilage and by the presence 
of fistulous tracts. 

Etiology and Occurrence. — The disease is due to the intro- 
duction of pus producing organisms into the subcoronary region 



LAMENESS IN THE FORE LEG 175 

of the foot under conditions which favor the retention of such 
contaginm and extension of infection into contiguous tissues. 

oMorbific material is introduced into the region of tlie lateral 
cartilage by means of calk wounds and other penetrant injuries 
of the foot. A sub-coronary abscess which, because of lack of 
proper care or because of virulency of the contagium or low 
vitality of the subject, is quite apt to result in cartilaginous 
affection and its perforation by necrosis follows. 

Symptomatology. — Quittor is readily diagnosed on sight in 
many instances. Where there is dependable history or other 
evidence of the chronicity of an infectious inflammation of the 
kind, quittor is easily identified. If no positive evidence of 
the disease exists, by means of careful exploration of sinuses 
with the jirobe, one may distinguish between true cartilaginous 
quittor and superficial abscess formation that is often accom- 
panied by hyperplasia. 

Lameness depends upon the extent of the involvement as it 
affects the structures contiguous to the cartilage. A varia])le 
degree of lameness is manifested in different eases. 

Treatment. — Two general plans of handling this disease are 
in vogue. One, the more popular metliod, consists in the in- 
jection of caustic solutions of various kinds into the fistulous 
openings with the object of causing sloughing of necrotic tissue 
and the stimulation of healthy granulation of such wounds. 
The other mode consists in either complete surgical removal of 
the cartilage or its remaining portions, or removal of the dis- 
eased parts of curettage. 

When quittor has not extensively damaged the foot and the 
lateral cartilage is not jiartly ossified as it is in some old chronie 
cases, the complete removal of the lateral cartilage by means of 
the Bayer operation or a modification thereof is indicated. A 
complete description of the Bayer operation as well as ^NFerillat's 
operation for this disease (the latter consisting in part, in the 
removal of diseased cartilage Avith the curette) are given in 
Volume three of IMerillat's "Veterinary Surgical Operations." 

Treatment by injection of caustic solutions has many advocates 
and because of the fact that, in manv instances the condition is 



176 



LAMENESS OF THE HORSE 



such that they are not desirable surgical cases and also because 
some animals may be put in service before treatment is com- 
pleted, the injection method is popular. 

The mode of treatment advocated by Joseph Hughes, M. R. 
C. V. S., constitutes a very successful manner of handling quit- 
tor and we can do no better than quote Dr. J. T. Seeley^ on his 
manner of using this particular treatment. 




Fig. 37 — Hyperplasia of right fore foot, due to chronic quittor. 



Preparation. — First remove the shoe, have the foot pared 
very thin and balanced as nicely as possible. Moreover, all loose 
fragments of horn must be detached and all crevices cleaned 
thoroughly. 

Next, have the leg brushed and hair clipped from the knee 
or hock to the foot and scrubbed with ethereal soap and warm 
water, after which the foot must be scrublied in like manner. 
The foot is then placed in a bichlorid bath several hours daily, 



^Quittor and Its Treatment by the Hughes Method, J. T. Seeley, M. D. C, 
Seattle, Washington, Chicago Veterinary College Quarterly Bulletin, Vol. 9, 
page 27. 



LAMENESS IN THE FORE LEG 



177 



for from two to five days, depending upon whether or not sore- 
ness is shown. The bichlorid solution is 1 to 1,000 strength. 

On removing the liorse from the bath a liberal layer of gauze 
is soaked in 1 to 1,000 bichlorid solution and placed so as to cover 
the entire foot. On discontinuing the bath, cover the foot with 
gauze saturated with a 1 to 1,000 bichlorid solution. This is to 
be covered with absorbent cotton and a gauze bandage, and over 





Fig. 38— Chronic quittor, left hind foot, 
of painfuhiess of the affection. 



Showing position assumed because 



all is placed an oil cloth or silk covering. This pack is kept moist 
with bichloride solution for forty-eight hours. The foot is then 
ready for injection. 

Preparation of the Injection Fluids. — Have on hand a pint 
of a one per cent aqueous solution of formaldehyd made under 
cleanly conditions, even to a clean bottle and cork, and a clean 
container when ready to use the liquid. Prepare also a bichlorid 
of mercury solution as follows: Ilydrarg. Chlor. Corros. oIV; 
Acid Hydrochlor. 5Iss. ; Aqua Bulliens, Oij. This should be 



178 LAMENESS OF THE HORSE 

thoroughly triturated, and then filtered into a clean bottle, when 
it is ready for use. 

Injection. — The patient should be laid on a table, if one is 
available, or cast, and the foot securely fixed. Then. Avith an 
ordinary one-ounce hard rubber syringe, with a good plunger 
(tried first to note whether or not any fluid works around be- 
tween the barrel and the plunger), introduce one syringe full 
of the formaldehyd solution, then thoroughly probe the quittor 
to detcFmine the number of sinuses. This done, inject each 
sinus. If two sinuses open on the surface, close one >vith cotton- 
while filling the other so that if there is a connection the solu- 
tion will come in contact with all tissues involved. Irrigate with 
the full pint of formaldehyd solution first, then follow with six 
or eight ounces of the bichlorid solution. Never probe the foot 
nor allow it to be tampered with except in the manner pre- 
.scribed. 

After-Treatment. — Put on a pack saturated with a solu- 
tion of ])ichlorid of mercury 1 to 1,000 and let it remain two 
days. Remove pack, and once daily afterwards wipe off with 
cotton the secretion which accumulates on the outside, and ap- 
ply a dry dressing or healing oil composed of phenol, camphor 
gum and olive oil. 

When Dangerous to Inject. — Never inject a quittor in the 
acute stage. Never inject a quittor if considerable lameness is 
present. On injecting a solution of formalin, hold cotton tightly 
around the nozzle of the syringe, when the plunger is doAm, 
then withdraw the syringe gently and note particularly if the 
fluid returns through the opening; if none returns cease opera- 
tions at once, as it is dangerous to proceed farther, it indicates 
that the sinus is not well defined and the fluid retained will 
cause much trouble and often the death of the patient. 

Experience has taught that, if extensive destructive changes 
of the foot exist, the Bayer operation is not indicated. In the 
country, where quittors are not so frequently met as in ur'^an 
practice, the Merillat operation is preferable in all cases. How- 
ever, the cost of the protracted period of idleness, which con- 
valescent surgical patients require, renders the Hughes method 
more satisfactory in the hands of the general practitioner, espe- 
cially in the city. 

Nail Punctures. 

Nail punctures, as herein considered, embrace all penetrant 
wounds of the solar surface of the horse's foot due to trampling 



LAMENESS IN THE FORE LEG 179 

upon street nails. This does not include accidental nail pricks 
occasioned in shoeing. In city practice, in some stal)les, these 
cases are of frecjuent occurrence; and, generally speakino-, nail 
punctures are observed more frequently in ur])an horses than 
in animals that are kept in the country. 

Occurrence and Method of Examination. — This condition, 
then, is a rather common cause of lameness and in no case, 
where cause of the claudication is not ob\ ious, is the practitioner 




Fig. 39— Skiagraph of foot. The X-ray offers very limited possibiHties in 
the diagnosis of lameness. The location of a "gravel" or a nail that had 
worked its way some distance from the surface, or of an abscess of some 
proportion, deep in the tissues, might be facilitated under some circumstances 
by the aid of the X-ray. Its use in the detention of fractures is very limited, 
owing to the difficulty encountered in getting a view from the right position — 
many trials being necessary in most cases. The case shown above was diag- 
nosed clinically as Incipient ringbone. The X-ray revealed no lesions. (Photo 
by L. Griessmann.) 

warranted in concluding his examination without careful search 
for the possible existence of nail puncture of the solar surface 
of the foot. 

In occasional instances tliere co-exists an obvious cause for 
supporting-le<J-lameness and an occult cause — a nail puncture 
Where such complications nvo met, the practitioner is not neces- 
sarily guilty of neglect or carelessness when the nail i)uncture 



180 LAMENESS OF THE HORSE 

is not discovered at once, nevertlieless, an examination is not 
complete until practically every possible cause of lameness lias 
been located or excluded in any given case. 

In a search for nail puncture it is necessary to expose to view 
every portion of the sole and frog in such manner that the 
existence of the smallest possible wound will be revealed. This 
necessitates removal of the shoe, if, after a preliminary ex- 
amination, a puncture is not found, when there is good reason 
to suspect its presence. However, where it is readily possible 
to locate and care for a wound without removal of the shoe, 
allowing the shoe to remain materially facilitates retaining 
dressings in position and relieves the solar surface of contact 
with the ground. If extensive injury or infection exists, it is 
of course necessary to remove the shoe and leave it off. By re- 
moving a superficial portion of all of the sole and frog, thus 
carefully and completely exposing to view all parts of the solar 
surface of the foot, and with the aid of hoof-testers one is enabled 
to positively determine the existence of nail punctures. Because 
of the tendency of puncture wounds of the foot to close, and 
since the superficial portion of the solar structures are usually 
soiled, it is absolutely necessary to conduct examinations of this 
kind in a thorough manner. 

Symtomatology. — Not all cases of nail puncture cause lame- 
ness during the course of the disturbance and in many instances 
no lameness is manifested for some time after the injury has 
been inflicted — not until infection has been the means of caus- 
ing considerable inflammation of sensitive structures. Never- 
theless, this lack of manifestation occurs only in cases where 
serious injury has not taken place and the degree of lameness 
is a constant and reliable indicator of the character and extent 
of nail punctures within twenty-four hours after injury has been 
inflicted. 

The position assumed by the affected animal inconstantly 
varies with the location and nature of the injury and is not 
of particular importance in establishing a diagnosis. The sub- 
ject may support some weight with the affected member and 
stand ''base-wide" or "base-narrow," or no weight may be 
borne with the foot or the animal may point or keep the ex- 



LAMENESS IN THE FORE LEG 181 

tremity in a state of volar flexion. In cases where extensive 
injury has been inflicted, and great pain exists, the foot is kept 
off the ground much of the time and it may be swung back and 
forth as in all painful affections of the extremity. 

Nail punctures cause typical supporting-leg-lameness and in 
some cases certain peculiarities of locomotory impediment are 
worthy of notice. Punctures of the region of the heel, which 
directly affect or involve the deep tendon sheath, cause a type 
of lameness wherein pain is augmented, when dorsal flexion of 
the extremity occurs as well as when weight is borne. Wounds 
in the region of the toe of the hind feet sometimes cause the 
subject to carry the extremity considerablj^ in advance of the 
point where it is planted and, just before placing the foot on the 
ground, it is carrie.d backward a little way — ten or twelve inches. 

However, diagnosis of nail puncture is ))ased on the finding of 
the characteristic wound or resultant local changes. 

Course and Prognosis. — The nature of the progress and the 
manner of termination of these cases are variable. If the coffin 
joint has been invaded, and a septic arthritis exists, the condi- 
tion is at once grave. An open and infected tendon sheath, 
while not so serious, constitutes a condition Avhich is distressing, 
and recovery is slow even under the most favorable conditions. 
Where a heavy, rigid and sharp nail enters the foot, in such 
manner that fracture of the third phalanx (os pedis) occurs, 
this complication makes for a protraction of the condition. Ex- 
perience teaches that the natural course and termination in 
these cases are modified by the location and depth of the injury, 
virulency of the contagium and resistance of the subject to such 
infection. 

Prevention. — In all horses which are kept at such w'ork that 
exposure to nail punctures is frequent, a practical means of pre- 
vention of such injuries consists in ^he employment of heavy 
sole leather or suita])le sheet metal to cover the sole of the foot 
and, at the same time, confine oakum and tar in contact with 
the solar surface to prevent the introduction of foreign material 
between the foot and such protecting appliances. Further, if 
drivers and owners could be impressed with the serious complica- 
tions which so frequently attend wounds of this kind, undoubt- 



182 LAMENESS OF THE HORSE 

edly many cases which are now lost, because of ignorance or 
neglect on the part of the teamsters or proprietors of horses, 
would be saved liy prompt and rational treatment. 

Treatment. — The treatment of this condition falls so largely 
within the dominion of surgery that we can give little more 
than an outline here. 

In cases where there exists no evidence of open joint or open 
tendon sheath as judged by the site of the puncture and degree 
of lameness present (after having thoroughly cleansed the solar 
surface of the foot and enlarged the opening in the nonsensitive 
sole) a little phenol is introduced into the wound. In such 
cases, where it is pos.sible for the antiseptic to contact every part 
of wound surface to the extreme depths of the puncture, in- 
fection is prevented when such treatment is promptly admin- 
istered. This may be considered as first aid, or emergency care, 
and is indicated in all wounds of the foot whether the injury 
be serious or almost insignificant. 

Subsequently one of two general courses may be pursued in 
the treatment of cases of nail puncture. One, by the employ- 
ment of means to keep the wound patent and injection of suit- 
able antiseptics, or agents that are more or less caustic in con- 
junction with strict observance of asepsis and wound protection. 
The other method consists in prompt establishment of drainage 
by surgical means and includes exploration and curettage. 

The first method is lietter adapted to the use of the average 
general practitioner and he would do well to keep the opening 
in the nonsensitive structures patent. By introducing equal 
parts of tincture of iodin and glycerin daily, good results will 
follow in most instances. The wound is protected in unshod 
horses, either by completely bandaging the foot and retaining, 
in contact with the wound, cotton that is saturated with iodin 
and glycerin, or, if a minor injury exists, the moderately en- 
larged opening in the nonsensitive sole or frog, which has been 
moistened with the antiseptic, is packed with a very small quan- 
tity of cotton. A little practice in this mode of closing benign 
puncture wounds will enalile the practitioner to successfully 
protect the sensitive parts in the treatment of such cases in un- 
shod country horses. 



LAMENESS IN THE FORE LEG 183 

When the condition progresses favorably the wound may be 
dressed every second day or twice weekly, and in the course of 
from two to six weeks recovery should be complete. 

If the practitioner is somewhat proficient as a surgeon, and 
has at his command facilities for doing surgery, the second 
method is preferable in many cases. By using a local anesthetic 
on the plantar nerves and confining the subject on an operating 
table, restraint should be perfect. The solar surface of the foot 
is first thoroughly cleansed, the puncture wound is enlarged in 
the nonsensitive structures and the parts are then moistened 
with phenol or other suitable antiseptics. By means of a small 
probe the puncture is explored and, depending on the character 
of the wound and the structures involved, surgical intervention 
is varied to suit the case. If necessary, all of the insensitive 
frog is removed, and in wounds affecting the region of the heel 
the tissues may be incised from the puncture outward dividing 
all of the tissues outward and backward to the surface. A 
suitable surgical dressing is then applied. 

If, on the other hand, the puncture extends into the navicular 
bursa, the radical operation is perhaps indicated, though not 
until one is sure that infection of the bursa and serious conse- 
quences are to follow if this operation is not performed. De- 
tailed description of the teehnie of this operation belongs to the 
realm of surgery and a good discussion of it is to be found in 
William's work on veterinary surgical and obstetrical opera- 
tions. 

One may summarize the discussion of treatment of nail punc- 
ture by saying that emergency care as herein described is of first 
consideration. In every case an immunizing dose of anti-tetanic 
serum should be given. Subsequently, the method emi'loyed 
must suit the character of the wound, existing facilities for 
handling the sul)joct and the skill and aptitude of the prac- 
titioner. 



SECTION IV. 
LAMENESS IN THE HIND LEG. 

Anatomo-Physiological Consideration of the Pelvic Limbs. 

The pelvic bones as a Avhole constitute the analogue of the 
scapulae with respect to their function as a part of the mechan- 
ism of locomotive and supportive apparatus of the horse. The 
manner of attachment or connection between the ilia and the 
trunk is materially different from that of the scapulae, how- 
ever, and the angles as formed by the long axes of the ilia in 
relation to the spinal column are maintained by two functionally 
antagonistic structures — the sacrosciatic ligaments, and the alj- 
dominal muscles by means of the prepubian tendon. The sacro- 
iliac articulations are such that a very limited amount of move- 
ment is possible; free movement, however, is unnecessary be- 
cause of the enarthrodial (ball and socket) femeropelvic joint. 

The various muscles which exert their effect upon the pelvis 
in changing their relationship between the long axes of the ilia 
and spinal column, are concerned but little more in propulsion 
and weight bearing than are the pectoral muscles. A general 
treatise on the subject of lameness does not properly include 
such structures any more than it does the various affections of 
the dorsal, lumbar and sacral vertebrae or inflammation of the 
abdominal parietes. Involvement of such parts cause manifesta- 
tions of lameness but the matter of establishing a diagnosis is 
difficult in many instances and in some cases impossible. 

The femeropelvic articulation is formed by the hemispherical 
head of the femur and the acetabulum ; the latter constituting a 
cotyloid cavity which is deepened by the cotyloid ligament. 

The round ligament (ligamentum teres) is the principal bind- 
ing structure of the hip joint and it arises in a notch in the 
head of the femur and is attached in the subpubic groove close 
to the acetabular notch. Another ligament, peculiar to Equidae 
— the accessory (pubiofemoral) — is attached to the head of the 
femur near the round ligament and passes through the cotyloid 

185 



186 



LAMENESS OF THE HORSE 



Tendon of per ^^ 

oneiis terltus » 

Tibial tarsal hour 



Medial ^ewlon o, 
tibialis anterior 



Tendon of 
gastrocnemius 

Superfinal 
flexor tendon 




Superficial flexor 
tendoyi 
Annular ligament 



Joint capsule {tarso- 
metatarsal ligament) 

Fourth tarsal 
Perforating tarsal vein 
Check ligament 
Suspensory ligament 



Fig-. 40 — Sagital section of right hock. The section passes through the 
middle of the groove of the trochlea of the tibial tarsal bone. 1 and 2. Prox- 
imal ends of cavity of hock joint. 3. Thick part of joint capsule over which 
deep flexor tendon plays. 4. Fibular tarsal bone (sustentaculum). A large 
vein crosses the upper part of the joint capsule (in front of 1). (From Sis- 
son's "Anatomy of tlie Domestic Animals.") 



Joint cavity 
Dorsal ligament ^\"*~7 

Central tarsal bone ' 

Third tarsal bone 



Mt. Ill 



LAMENESS IN THE HIND LEG 



187 



Lateral ridge of trochlea of femur 
Lateral fcinnro-tihial ligament 

Lateral inerascu'^ 
Lateral condyle of tibia 

Long extensor {stump) 

Peroneus tertius 
Tibialis anterior 
Lateral extensor 



Tendinous loo] 



Extensor brem 



Tendon of lateral extensor 
Tendon of lung extensor 




Medial ridge of trochlea of femur 



Medial meniscus 
7^ Medial femoro-tibial ligament 



Tendon of long extensor 
Annular ligament 



Peroneus tertius 



Medial tendon of tibialis anterior 

Anterior tendon of tibialis anterior 
Anterior tendon of peroneus terlius 

Annular ligament 
Mt 111 



FiK. 41-Mius(les of right leg; tin, it view. The greater part of the long 
extensor has been removed. 1, 2, 3. Stumps of patellar ligaments. -1 
Tuberosity of tibia. (From Sisson's "Anatomy of the Domestic Animals.') 



188 LAMENESS OF THE HORSE 

notch and along the under side of tl]e pubis. It is inserted or 
blends with the prepubic tendon. This ligament prevents ex- 
treme abduction of the leg. The joint capsule encompasses the 
articulation and is attached to the brim of the acetabulum and 
the edge of the head of the femur. 

The stifle joint is analagous to the knee joint of man and is 
to be considered an atypical ginglymus (hinge) articulation 
formed by the femur, tibia and patella. The ligaments are 
femerotibial, femeropatellar and capsular. 

In addition to the usual provision for articulation of bones 
there are situated cartilaginous menisci between the condyles 
of the femur and the head of the tibia. These discs surround 
the tibial spine and are otherwise shaped to fit perfectly between 
the articular portions of the femur and tibia. 

Collateral ligaments (internal and external lateral) pass from 
the distal end of the femur to the proximal portion of the tibia. 
The mesial (internal) arises from the internal condyle of the 
femur and is attached to a rough area beloAV the margin of the 
medial (internal) condyle of the tibia. The lateral (external), 
shorter and thicker, arises from the depression on the lateral 
epicondyle and inserts to the head of the fibula. 

The crucial or interosseus, anterior and posterior, are situ- 
ated between the femur and tibia, and according to Smith,^ 
the crucial ligaments are necessary to properly join the two 
bones, because of the character of the structure of the articular 
ends of the femur and tibia. 

The femeropatella ligaments are two thin bands which re- 
inforce the capsular ligament. They arise from the lateral 
aspects of the femur, just above the condyles and are inserted 
to the corresponding surfaces of the patella 

The patellar ligaments are three strong bands which arise 
from the antero-inferior surface of the patella, and are inserted 
to the anterior aspect of the tuberosity of the tibia. 

Taken as a whole, the tarsal bones, interarticulating and articu- 
lating with the tibia and metatarsal bones form the hock joint 
and this articulation is analagous to the carpus. As with the 
carpus, there is less movement in the inferior portion of the 



^Manual of Veterinary Physiology. Page 610. 



[LAMENESS IN THE HIND LEG 



189 



Patella 



Cresl of tibia 

Long digital cxlensor 
Lateral digital extensor 




Branch of suspensory ligament to 
extensor tendon 



■ Gastrocnemius, lateral head 

- Sulcus 
• Tendon of gasirociiemius 

Tarsal tendon of biceps femoris 

- Deep flexor 



Proximal annular ligament r ^ W%\ 

Lateral malleolus 

Middle annular ligament 

Distal annular ligament 

Tendon of long extensor l| 

Tendon of lateral extensor s: 



..^ Superficial 
■' flexor tendon 



iy 




Superficial flexor 
tendon 

Deep flexor tendon 

Suspensory 
ligament 



¥-ig. 42— Muscles of lower part of thigh, leg and foot; lateral view. o'. 
Fascia lata; q, q', q", biceps femoris; r, semitendinosus; 21', lateral condyle 
of tibia. The extensor brevis is visible in the angle between the long and 
lateral extensor tendons. (After Ellenberger-Baum. Anat. fiir Kunstler.) 
(From Sisson's "Anatomy of the Domestic Animals.") 



190 



LAMENESS OP THE HORSE 



joint than in the superior part of the articulation. The chief 
articulating parts are the tibia with the tibial tarsal bone (astra- 
gulus) . 

The capsular ligament is attached around the margin of the 
articular surfaces of the tibia, to the tarsal bones, the collateral 



Proximal end of 
femoru- patellar 



Lateral head of gastrocnemius 

Lateral fcmoro-patellar ligament 

Attachment of joint capsule 

Lateral condyle of femur 

Lateral fcmoro-tibial ligament 

PopHtcus 



Deep digital flexor 




Base of patella 



Lateral rxtcnsnr 



Distal end of capsule 
Middle patellar ligament 
Medial patellar ligament 

Lateral patellar ligament 
(stump) 

Tuberosity of tibia 
Tibialis anterior 

Long extensor 



Fig. 43 — Right stifle joint; lateral view. The femoro-patellar capsule was 
filled with plaster-of-Paris and then removed after the cast was set. The 
femoro-tibial capsule and most of the lateral patellar ligainent are removed. 
M. Lateral meniscus. (From Sisson's "Anatomy of the Domestic Animals.") 

ligaments (internal and external lateral) and to the metatarsus. 

The common ligaments of the tarsal joint are the collateral, 
the plantar (calcaneo-metatarsal and c. cuboid) and dorsal liga- 
ments (oblique). 

The medial (internal lateral) ligament serves to join the 
medial (internal) tibial malleolus with tibial tarsal (astragulus) 
and other tarsal bones. 



LAMENESS IN THE HIND LEG 



191 



The lateral (external lateral) ligament is inserted to the lateral 
(external) tibial malleolus and its distal portions are attached 
to the tibial tarsal (astraguliis), fibular tarsal (ealcaneum) bone, 
fourth tarsal (cuboid) and metatarsus bones. 



liusc of jiaUlla 



A ccinanrij i-.irtiluje 



Medial condyle of 
femur 
Medial femoro-tibial 
ligament 
Medial meniscus 

Medial condyle of 
tibia 




Medial ridge of trochlea 



Medial patellar ligor 
mail 



Middle patellar liga- 
ment 



Tuberosity of tibia 



Fig. 44 — Left stifle joint; medial view. The capsules are removed. (From 
Sisson's "Anatomy of the Domestic Animals.") 

The plantar ligament (ealcaneo-cuboid) is a strong flat band 
which is attached to the plantar surface of the fibular and fourth 
tarsal bones (ealcaneum and cuboid) and the head of the lateral 
metatarsal (external small) bone. 

The dorsal (oblique) ligament is attached above to the distal 
tuberosity on the inner side of the tibia. It is inserted below to 
the central (cuneiform magnum) and third (c. medium) tarsal 



1»2 LAMENESS OF THE HORSE 

hones, to the proximal ends of the large and outer small meta- 
tarsal bones. 

The tarsus is a true hinge joint and because of the great 
strain which it sustains, is subject to frequent injury. About 
seventy-five percent of cases of lameness affecting the hind leg 
may be said to arise from disease of the hock. 

As members of locomotion the legs receive strains of two kinds : 
those of concussion and weight-bearing and strains of propul- 
sion ; the latter are the greater. In the horse as a work animal, 
the hind legs are probably subjected to greater strains than are 
the front but the manner of construction of the various parts 
of the pelvic limbs with the possible exception (according to 
some authorities) of the tibial tarsal joint, offsets this condition. 

The femur may be considered analagous to the humerus in 
that it bears a similar relationship to the ilium, that exist be- 
tween the humerus and scapula. Further flexion during repose 
is prevented chiefly by the gluteus medius (maximus) muscle 
and its tendons. The larger tendon inserts to the summit of the 
trochanter major of the femur and corresponds to the biceps 
brachii in the action of the latter on the scapulohumeral joint, 
except that the gluteus medius, in attaching to the femoral 
trochanter, exerts its effect as a lever of the first class. Because 
of the relationship between the long axes of the femur and iliac 
shaft it is evident that the angle formed by these two bones 
is maintained chiefly by the gluteus muscles during weight bear- 
ing. Contraction of muscular fibers of the gluteus medius causes 
extension of the femur and muscular strain is prevented to a 
great degree by the inelastic portion of this muscle. The chief 
physiological antagonistics of the glutei are the quadriceps 
femoris and tensor fascia lata. 

"While the leg is supporting weight the stifle joint is fixed in 
position mainly by the quadriceps femoris group of muscles 
which are attached to the patella. Tendinous fibres intersect 
this muscular mass and relieve muscular strain during weight 
bearing. Because of the manner in which the patella function- 
ates with the trochlea of the femur, comparatively little energy 
is required to prevent further flexion of the stifle joint. The 



(LAMENESS IN THE HIND LEG 



193 



patella, according to Strangevvays, may be considered a sesamoid 
bone. 

The quadriceps group of muscles is assisted by the anterior 
digital extensor (extensor pedis) peroneus tertius and tibialis 



Ft mil. 



Accessor!/ carlilnge of 
paUila 



Mahal ridge nj trocldea — 
Medial patellar ligament 

Medial epicondyle 



Medial femoro-libial 
ligament 

Medial meniscus 
Medial condyle of tibia 



Tuberosity of tibia 




Biceps femoris 

Lateral patellar ligament 



Lateral femoro-libial 
ligament 

Lateral meniscus 



Lateral condyle of libia 



[ nterosseoiis space 

Fibula 

Interosseous ligament 



Fig. 45 — Left stifle joint; front view. The capsules are removed. 1. Middle 
patellar ligament. 2. Stump of fascia lata. 3. Stump of common tendon of 
extensor longus and peroneus tertius. (From Sisson's "Anatomy of Domestic 
Animals.") 

anticus (flexor metatarsi) muscles. The latter pair (flexor 
metatarsi, muscular snd tendinous portions, because of their 
attachment to the external condyle of the femur and to the 
metatarsal bone) are enabled to automatically flex the tarsal 
joint when the stifle is flexed. 



194 LAMENESS OF THE HORSE 

The hock is kept fixed in position by the gastrocnemius and 
the superficial digital flexor (perforatus). The latter structure, 
which is chiefly tendinous, originates in tlie snpracondyloid fossa 
of the femur and has an insertion to the summit of the fibular 
tarsal (calcis) bone. It relieves the gastrocnemius of muscular 
strain during weight bearing. 

Smith^ styles the function of the stifle and hock joints a re- 
ciprocating action, and we quote from this authority the follow- 
ing: 

From what has been said, it is evident that flexion and ex- 
tension of stifle and hock are identical in their action. When 
the stifle is extended, the hock is automatically extended, nor 
can it under any circumstances flex without the previous flexion 
of the stifle. There is no parallel to this in the body. The two 
joints, though far apart, act as one, and they are locked by the 
drawing up of the patella, and in no other way. The so-called 
dislocation of the stifle in the horse is a misnomer. That the 
patella is capable of being dislocated is beyond doubt, but the 
ordinary condition described under that term, when the stifle 
and hock are rigid while the foot is turned back with its wall 
on the ground, is nothing more than spasm of the muscles which 
keeps the patella drawn up. The moment they relax the pre- 
viously immovable limb and useless foot have their function 
restored as if by magic, but are immediately thrown out of gear 
in the course of a few minutes as a recurrence of the tetanus of 
the petallar muscle takes place. The fascia of the thigh, like 
that of the arm, is a most potent factor in giving assistance to 
the constant strain imposed on the muscles of the limbs during 
standing. 

Below the hock the hind limb is arranged like that of the fore, 
the deep flexor (perforans) receiving its additional support from 
the "check ligament," as in the fore leg. 

The natural attitude of standing adopted by the horse is to 
rest on three legs — one hind and two fore. If he is alert, he 
stands on all four limbs; but if standing in the ordinary man- 
ner, he always rests on one hind leg. He does not remain long 
in this position without changing to the other. Hour by hour 
he stands, shifting his weight at intervals from one to the other 
hind leg, and resting its fellow by flexing the hock and standing 
on the toe. He never spares his fore-limbs in this manner in a 
state of health, but always stands squarely on them. 

iManual of Veterinary Physiology, page 601. 



LAMENESS IN THE HIND LEG 195 



Hip Lameness. 



Fortunately, because of the heavy inuscuhitiire which goes 
to form a part of the locomotive apparatus of the rear extremity, 
hip lameness is comparatively rare. While the term is in itself 
ambiguous and signifies nothing more definite than docs "shoul- 
der lameness," yet diagnosis of almost any condition that may 
be classed under the head of "hip lameness" is not easy except in 
cases where the cause is obvious, as in W'Ounds of the musculature 
and certain fractures. To the complexity which the gait of the 
quadruped contributes, because of its being four-legged, there 
is added the complicated manner of articulation of the bones of 
the hind leg. This involves the hip in the manner of diagnostic 
problems and because of the inaccessibility of certain parts, 
owing to the bulk of the musculature of these parts, diagnosis 
of some hip ailments becomes an intricate problem. Conse- 
quently, in some instances, before one may arrive at definite 
and enlightening conclusions, repeated examinations are neces- 
sary as well as a knowledge of reliable history and recorded 
observations of the subject over a considerable period. 

Rheumatic affections, when present, usually cause recurrent 
attacks of lameness; myalgia, due to subsurface injur.y occasioned 
by contusion, generally produces an ephemeral disturbance ; and 
while these are examples of cases wdiere occult causes are active, 
they are by no means unprecedented. In cases where the cause 
of lameness is not definitely located, and when by the process 
of exclusion one is enabled to decide that the seat of trouble is 
in the hip, a tentative diagnosis of hip lameness is always ap- 
propriate. 

In one instance a Shetland pony evinced a peculiar form of 
intermittent lameness which affected the left hip, and repeated 
examinations did not disclose the cause of the trouble. After 
about a year there was established spontaneously an opening 
through the integument overlying the region of the attachment 
of the psoas major (magnus), through which pus discharged. 
With the occurrence of this fistula, lameness almost entirely 
disappeared, but the emission of a small amount of pus persisted 
for more than a year. The subject was not observed thereafter 



196 LAMENESS OF THE HORSE 

and the outcome in this ease is not a matter of record. Whether 
there existed a psoic phlegmon due to metastatic infection or 
necrosis of a part of a lumbar or dorsal vertebra is a matter for 
speculation. Thus the presence of some anomalous conditions 
which affect the pelvic region and cause lameness may be dis- 
covered, yet both in hip and shoulder regions causes may not be 
definitely located by means of practical methods of examination. 

Injuries of all kinds are the more frequent causes of hip lame- 
ness. In such cases, lameness may result directly and resolution 
be prompt, or the claudication become aggravated in time, due 
to muscular atrophy or degenerative changes affecting the hip 
joint or nerves. Rheumatism or metastatic infection may be 
the cause of hip lameness as well as affections of the pelvic bones, 
lumbar and sacral vertebrae. Hip lameness may also be pro- 
voked by melanotic or other tumors. 

In the diagnosis of hip lameness, one is guided in a general 
way by the character of the impediment manifested. Swinging- 
leg lameness is often present and the impediment is more ac- 
centuated when the animal is caused to step backward. In many 
cases lameness is mixed, being about equally noticeable during 
weight bearing and while the member is being swung. By ex- 
clusion of causes which might affect other partS; one may defi- 
nitely locate the cause of the trouble or determine that a certain 
region is affected. 

The sudden manifestation of lameness is indicative of injury; 
thermic disturbances may signalize metastatic infection ; history, 
if dependable, is always helpful. Repeated observations, taking 
into account the course which the affection assumes during a 
period of a few days, often serve to afford a means of establish- 
ing a diagnosis in baffling cases. 

Fractures of the Pelvic Bones. 

The OS innominatum may be so fractured that the pelvic girdle 
is broken, as in fracture of the iliac shaft, or in a manner that 
the girdling continuity of the innominate bones is not inter- 
rupted. It naturally follows that greater injury is done when 
the pelvic girdle is broken than when it is not, except in cases 



[LAMENESS IN THE HIND LEG 197 

where the aeetabiihim is involv^ed and its brim not completely 
divided. 

Etiology and Occurrence. — Pelvic fractures are usually 
caused by falls or other manner of contusion. Cases are re- 
ported where it would seem that fracture of the iliac angle re- 
sulted from muscular contraction, but it is certain that most 
fractures of this kind are due to collisions with door jambs or 
similar injuries. In old horses especially, fracture of pelvic 
bones occurs frequently. This form of injury is of more frequent 
occurrence in animals of all ages that work on paved streets. 
The country horse is not subjected to the uncertain footing of 
the slippery pavement, nor to injuries which compare with those 
caused by contusions sustained in falling upon asphalt or cobble- 
stones. 

Symiptomatology. — While in many cases of pelvic fracture 
lameness or abnormal decumbency are the salient manifestations, 
yet the pathognomic symj^toms are crepitation or palpable evi- 
dence which may be obtained by rectal or vaginal examination. 
In fractures of the angle of the ilium and the ischial tuberosity, 
perceptible evidence always exists. 

In cases where fracture of some portion of the pelvic girdle 
is suspected and the subject is able to walk, crepitation is sought 
by placing one hand on an external angle of the ilium and the 
other on the ischial tuberosity and the tmimal is then made to 
walk. Or, by placing the hands as just directed, an assistant 
may grasp the horse's tail and by alternately exerting traction 
on the tail and pushing against the hip in such manner that 
weight is shifted from one leg to the other, crepitation may be 
detected. 

Fracture of the pubis near its symphysis constitutes a grave 
injury, as there is danger of the bladder becoming caught in the 
fissure and perforation of its wall may result. Such a case is 
reported by Bauman^ wherein a three-year-old gelding bore the 
history of having been lame for ten days. Upon rectal examina- 
tion the bladder was found to be hard and tumor-like and about 
the size of a baseball. The body of the ischium in this case 



^Case report at meeting- of the Iowa State Veterinary Medical Association, 
Jan., 1904, by Dr. S. H. Bauman, Birmingham, la. 



198 LAMENESS OF THE HORSE 

was fractured and a rent in the bladder was caused by a sharp 
projecting piece of bone. Autopsy revealed, in addition to the 
fracture and rent of the bladder wall, a large quantity of urine 
in the peritoneal cavity. 

In other instances hemorrhage caused death and not infre- 
quently infection w^as responsible for a fatal issue. Moller,^ 
quoting Nocard, describes a ease Avhere fracture occurred through 
the region of the foramen ovale and paralysis of the obturator 
nerve followed. 

Fractures Avhich include the acetabular bones cause great pain. 
This is manifested by marked lameness, both during weight 
bearing and when the member is swung. Such cases terminate 
unfavorably — complete recovery is impossible. 

Where small portions of the angle of the ilium are broken, and 
the skin is left intact, there exists the least troublesome class 
of pelvic fracture. If large portions of the ilium are fractured, 
considerable disturbance results. There eventually occurs more 
or less displacement in such cases, if such displacement does not 
take place at the time of injury. The same may be said of frac- 
ture of the tuber ischii, but when these bones are fractured a 
more serious condition results. 

Treatment. — When a case is found to be uncomplicated, that 
is, if the fracture is such that recovery seems possible and after 
having determined that treatment may be practicable, the first 
consideration is that of confining the subject in suitable slings. 
In many cases of pelvic fracture, the atfected animal will need 
to be kept in slings from six weeks to three months, and it be- 
comes a difficult problem to minimize the distress during this 
long period of confinement in the peculiar manner required for 
favorable outcome. 

The pattern of sling employed should be the best that is ob- 
tainable and the matter of its adjustment is quite important lest 
unnecessary chafing or even necrosis of skin result. Frequent 
readjustment may be necessary, and time is well spent in this 
manner since this contributes materially toward a favorable 
termination by encouraging the subject to remain quiet so that 



^Regional Veterinary Surgery and Operative Technique, by John A. W. 
Dollar, M. R. C. V. S., F. R. S. E., M. R. I., page 733. 



LAMENESS IN THE HIND LEG 199 

coaptation of the broken bones may be maintained. Aside from 
slings, mechanical appliances that are helpful in the treatment 
of these cases are not yet in use. 

A regimen that is nutritive and at tlie same time laxative is 
essential and in some cases cathartics and eueraata are necessary. 
Also, during the first few days, if there is retention of urine, 
catheterization is miperative. In a Avord, the handling of such 
cases consists largely in keeping the subject inactive, as com- 
fortable as possible, and giving attention to suitable diet. 

Simple fracture of the external iliac angle needs no particular 
attention, except that the subject is kept quiet until lameness 
subsides. In all cases where much of the bone is broken, the ani- 
mal is blemished, but interference with function does not follow. 
If infection results because of a compound fracture, loose pieces 
of bone must be removed surgically and drainage provided for. 

In fracture of the ischial tuberosity, infection is more apt to 
result than in like injury of the ilium, and greater displacement 
of bone occurs. This displacement, due to contraction of the 
attached muscles, is in some instances a contributing cause to 
the infection which often follows in these cases. In females 
where the body of the ischium is fractured, lacerations of the 
vagina may be present, and this constitutes a serious complica- 
tion which usually terminates fatally. 

After-care in fracture of the pelvic girdle consists principally 
in allowing a protracted period of rest before subjects are put 
to work. 

Fractures of the Femur. 

Etiology and Occurrence. — This is a comparatively rare in- 
jury in the horse because of the protection afforded the femur 
by the heavy musculature. Fragilitas of the bone probably 
exists in many cases when fracture of its diaphysis occurs. It 
is generally conceded that the neck of the femur is rarely broken 
because of a lack of constriction in this part, but fracture of the 
trochanters has been recorded rather frequently. However, 
Lienaux and Zwanenpoete^ state that fracture of the neck of 
the femur is of frequent occurrence in Belgian colts. Tapley- 



lAs quoted by A. Liautard, M. D., V. INI., American Veterinary Reviow, 
Vol. 37, page 667. 

^Quoted by Prof. Liautard, American Veterinary Review, Vol. 33, page 100. 



200 



LAMENESS OF THE HORSE 



reports in the Veterinary Journal (English) fracture of the head 
and internal trochanter of the femur and patellar luxation oc- 
curring simultaneously affecting a mule. In this case the mule 
was found decumlient on a concrete floor. After three weeks, 
the subject was destroyed and autopsy revealed rupture of the 
left pubiofemoral ligament, tearing with it a portion of the 
articular surface of the femur. The internal trochanter was 
also fractured in four sraall pieces. In this case it is fair to 
suppose that the mule in trying to regain footing on a slippery 
floor violently abducted the legs and fracture resulted. It is 




Fig. 46 — Oblique fracture of the femur of a 1,500 six-year-old draft horse. 
Showing shortening of bone, owing to a lateral approximation of the diaphysis 
because of muscular contraction. Photo by Dr. Edward Merillat. 



possible also that a temporary luxation of the patella took place 
first and caused the animal to struggle in such manner that frac- 
ture followed. 

Symptomatology. — According to Cadiot and Almy,^ "regard- 
less of the location of femoral fractures, the subject is usually 
intensely lame, the animal frequently walking on three legs — 
fractures of the diaphysis are characterized by an abnormal mo- 
bility." 

As a rule, crepitation is to be recognized in fractures of the 



^Traite de Thgrapeutique Chirurgical des Animaux Domestique par P. J. 
Cadiot et J. Almy, Tome second, page 460. 



LAMENESS IN THE HIND LEG 201 

shaft of the bone, by passively moving the leg to and from the 
medial plane (adduction and abduction). 

Fracture of the trochanter major is signalized by local swelling 
and evidence of pain; the forward stride is shortened because 
this movement tenses the tendon of the gluteus major (maximus) 
which is attached principally to the trochanter. 

Treatment.— Reduction of femoral fracture in the horse is 
practically impossible, and retaining the broken bones in coapta- 
tion is not possible by means of mechanical appliances. Conse- 
quently, prognosis is unfavorable in fracture of the body of the 
femur. AVhen union of bone occurs, there results shortening of 




Pig 47_Same bone as in Fig-. 46 after about six months' treatment. Tn this 
case Dr. Merillat employed a weight to counteract muscular contraction. It 
is noticeable that very little provisional callus has formed in this case, and 
in spite of unusual ingenuity and good facilities for caring for the subject, 
union of bone did not occur. 

the leg and animals are rendered i)ermanently lame. If the 
immediate region of the head of the bone is involved as well as 
in case of fracture of the condyles, an incurable arthritis ensues. 
Where the trochanters are broken, chronic lameness and 
muscular atrophy is the result. Therefore, it is evident that, 
because of the manner of function of the femur, the leverage 
afforded by its great trochanter and its heavy muscular attach- 
ments, fractures of this bone in the horse do not terminate favor- 
ably. 

Luxation of the Femur. 

Etiology and Occurrence. — Uncomplicated femoral luxation 
is of less frequent occurrence in the horse than in the other 



202 LAMENESS OF THE HORSE 

domestic animals. The deep cotyloid cavity renders disarticula- 
tion difficult and luxation does not often take place. Complica- 
tions that usually occur are rupture of the round (coxofemoral) 
ligament or fracture of the neck of the feinur. Falls or violent 
strains are necessary to produce this luxation. Goubaux is 
c[uoted by Cadiot and Almy^ as having observed the head of the 
femur in an instance wherein luxation had long existed. In this 
case autopsy revealed the fact that the inner portion (two-thirds) 
of the head of the femur had completely disappeared. 

Luxation of the femur is observed in old emaciated animals 
that are worked on slippery pavements. Occasionally, evidence 
of chronic luxation of the femur is observed in the anatomical 
laborator5^ The chronicity of the condition is obvious when 
one notes the well formed articulation Avhich Nature provides 
for the head of the femur, where fractui'C or other serious com- 
plications are not present. 

Symptomatology. — In every case there must exist either 
restriction of movement or an evident abnormal position of the 
leg, or both conditions may exist at once. Also, the leg may be 
markedly shortened. Manifestation of this affection varies, de- 
pending upon the character of the luxation (position of the 
head of the humerus with relation to the acetabulum). Lusk^ 
cites a case of a mule which had suffered femoral luxation. The 
animal was destroyed and on autopsy the head of the fenmr 
found to be contained within a false articular cavity situated 
about four inches above the acetabulum. In Dr. Lusk's case as 
he states it, the following symptoms were presented: "Limb 
shortened and fixed in a position of adduction. While standing 
the affected limb hung directly across and in front of the oppo- 
site one; upper trochanter very prominent; skin over hip joint 
very tense. The mobility of the limb was very limited, especially 
in the forward direction." 

Being very prominent when there is an upward luxation and 
less perceptible in downward displacement, the location of the 
trochanter major is an indicator of the character of the luxation 
with respect to the position of the head of the femur. This 



iTraite de Thgrapeutique Chirurgrical, Tome second, page 465. 
^Luxation of the Femur, by Wm. V. Lusk. Veterinary Surgeon, U. S. 
Cavalry, American Veterinary Review, Vol. 21, page 254. 



LAMENESS IN THE HIND LEG 203 

variation of position causes abnormal tenseness or looseness of 
the skin over the region of tlie trochanter major. Rectal ex- 
amination is of aid in locating the head of the humerus. 

Treatment. — Wlien it is evident that a subject should be 
given treatment and not destroyed, the animal must be cast and 
completely anesthetized. With complete relaxation thus secured 
by rotation of the limb, using the hip joint region as a pivot, re- 
duction may be effected. Traction is exerted in the same direction 
from the acetabulum that the head of the femur is situated and 
by pressing over the joint, the displaced bone may be returned 
in position. If luxation is downward, traction on the extremity 
will tend to dislodge the head of the femur from the inferior 
acetabular margin making reduction possible. 

The same general plan which is ordinarily employed in cor- 
recting luxation is indicated here, but because of the heavy 
musculature of the hip, complete anesthesia is imperative in all 
such manipulations. 

Gluteal Tendo-Synovitis. 

The gluteus medius (g. maximus) muscle is inserted chietly by 
means of two tendons ; one to the summit of the trochanter major 
of the femur and the other passing over the anterior part of the 
convexity of the trochanter, and being attached to the crest be- 
low it. The trochanter is covered with cartilage, and a bursa 
(the trochanteric) is interposed between the tendon and the 
cartilage. 

Etiology and Occurrence. — This affection is proliably caused 
in most instances l)y direct injury to the parts, such as may be 
occasioned by being kicked, falling on pavement, or being struck 
by the liody of a heavy wagon. Strains in pulling or in slipping 
are undoubtedly causative factors and in draft horses such 
strains may result in involvement of this synovial apparatus. 

Symptomatolog-y. — If pain be severe and inflammation 
acute, weight may not be borne with the affected member. There 
is some local manifestation of the condition in acute cases. 
Swelling of the tissues contiguous to the bursa is present and 



204 LAMENESS OF THE HORSE 

l)ain is evinced upon manipulation of the parts. A character- 
istic gait marks inflammation of the trochanteric bursa, and as 
Gunther has put it, the subject generally moves or trots as does 
the dog — the sound member being carried in advance of the 
affected one and the forward stride of the diseased leg is short- 
ened. In some chronic cases crepitation is discernible by holding 
the hand on the trochanter while the subject walks. 

Treatment. — In the first stages of an acute affection abso- 
lute quiet must be enforced; local antiphlogistic applications 
are beuefioial. Later, vesication of a liberal area surroundir^g 
the trochanter major is indicated. Where the condition has be- 
come chronic in horses that are to be kept at heavy draft work 
there is little chance for complete recovery. And, naturally, 
one is not to expect resolution in cases where there exist erosion 
and ossification of cartilage — where crepitation is discernible. 

Paralysis of the Hind Leg. 

Aside from paraplegic conditions due to disease of the cord or 
the lumbosacral plexus, and monoplegia affections resultant from 
disturbances of this plexus, paralysis of certain nerves are oc- 
casionally encountered. 

Anatom,y. — The lumbosacral plexus results substantially 
from the union of the ventral branches of the last three lumbar 
and the first two sacral nerves, but it derives a small root from 
the third lumbar nerve also. The anterior part of the plexus 
lies in front of the internal iliac artery, between the lumbar 
transverse processes and the psoas minor. It supplies branches 
to the iliopsoas^ (designated by Girard, the iliacomuscular 
nerves) . The posterior part lies partly upon and partly in the 
texture of the sacrosciatic ligament. From the plexus are de- 
rived the nerves of the pelvic limb (Sisson). 

Paralysis of the Femoral (Crural) Nerve. 

Anatomy. — The femoral nerve (crural) is derived chiefly 
from the fourth and fifth lumbar nerves. It runs ventrallv 



^Because of the intimacy of the psoas major (p. magnus) and the iliacus 
they are sometimes called Iliopsoas. 



[LAMENESS IN THE HIND LEG 205 

and backward, at first between the psoas major and minor, tlien 
crosses the deep face of the tendon of tlie latter and descends 
under cover of the sartorious over the terminal part of the 
ilio[soas. It innervates the psoas major (magnus), psoas minor 
Cparvus), sartorious, rectus femoris, vastus lateralis (internus). 
Branches supply the stifle and the adductor and pectineus mus- 
cles. 

Etiology and Occurrence. — While paralysis of the femoral 
nerve, also known as ''dropped stifle" occurs as a result of local 
injuries and melanotic tumors in gray horses, most cases are due 
to azoturia. So-called crural paralysis or "hip swinney" is oc- 
casionally observed but this is not a condition wherein the nerve 
is affected in the manner that characterizes the marked atrophy 
of quadriceps femoris (crural) muscles in some cases of hema- 
globinuria. This form of paralysis according to Hutyra and 
Marek is due primarily to diffuse degeneration of the muscles. 

Symptomatology. — When muscular atrophy is not extensive 
no particular evidence of this condition may be manifested while 
the subject is at rest, but where muscular waste has occurred, 
the nature of the ailment is at once recognized. Since the fem- 
oral nerve supplies the quadriceps femoris muscles, it follows 
that when the psoic portion of this nerve becomes diseased, the 
stifle loses its support, and in a unilateral involvement when the 
subject attempts to walk on the affected member, the stifle sinks 
down for want of support and the leg collapses unless weight is 
caught up with the other leg. Often, following azoturia, a 
bilateral affection is to be observed. 

Treatment. — Horses may be restrained in the standing posi- 
tion, and in the average instance, a twitch and hood are all the 
restraining appliances necessary. 

In cases where the disease is unilateral and atrophy is not of 
too long standing, recovery is possible in vigorous subjects. All 
affections, however, wherein degenerative changes involve the 
nerve trunk, whether due to diffuse myositis or pressure from 
malignant tumors, will not yield to treatment. 

The same general plan of treatment is indicated that is de- 
scribed on page 74 in the consideration of atrophy of the 



206 LAMENESS OF THE HORSE 

scapular muscles. It is especially important to provide for the 
subject to be exercised Avlien there is atrophy of the quadriceps 
muscles following azoturia. 

In addition to the foregoing, good results have attended the 
use of intramuscular injections of oxygen. The technic of the 
operation consists in preparing the area of skin which covers 
the atrophied muscles as for any operation. The hair is clipped 
over five or six or more circular areas of about an inch in diame- 
ter; the skin is cleansed and then painted with tincture of iodin. 

A long heavy sterile needle, which is connected with an oxygen 
tank by means of six feet of rubber tubing, is thrust into the 
depths of the affected muscles and the gas is gently introduced 
into the tissues. One needs exercise extreme care that the gas 
enter slowly because great pain is produced by the sudden in- 
jection of the oxygen. Likewise too much of the gas must not 
be introduced at one place. When the oxygen is slowly intro- 
duced it may be allow^ed to enter the tissues until the subject 
gives evidence of experiencing considerable pain, or if the parts 
are not particularly sensitive, a reasonable amount (enough to 
cause a mild degree of diffuse inflammation) is introduced at 
each one of five or six points. In large animals more points 
of injection may be used. 

No infection or other bad results will follow the execution of 
a good technic and the treatment may be repeated every three 
or four weeks until either marked regeneration of tissue is evi- 
dent or the case is obviously proved hopeless. 

Paralysis of the Obturator Nerve. 

Anatomy. — The obturator nerve, situated at first under the 
peritoneum, accompanies the obturator arteiy through the ob- 
turator foramen and gaining the uniscles on the internal faee 
of the thigh, terminates in the obturator externus, adductors, 
pectineus and gracilis, also giving twigs to the obturator in- 
ternus ( Strange ways) . 

Etiology and Occurrence. — This condition occurs upon rare 
occasions as the result of injury such as falls which cause ex- 
treme abduction of the legs, or in pelvic fracture where the 



LAMENESS IN THE HIND LEG 207 

nerve is tliivctly injured, or when nielanotic tumors or other 
new growths eonipress the nerve in such manner that its function 
is suspended. Paralysis of tlie oljturator nerve or nerves is met 
with rather frequently, notwithslandinii-. in mares, following 
dj^stoeia. The nerves (one or both) may heconie bruised at the 
brim of the obturator foramen by being caught between the pel- 
vis and the l)ody of the fetus in some cases of protracted labor. 

Symptomatology. — Tn a unilateral affection there umy be 
little evidence of the trouI)le while the subject is standing: or 
there is to be seen scune abduction: or the affected member may 
present abduction of the stifle and stand ''toe outward." If 
the animal is walked there will l)e manifested more or less abduc- 
tion and the character of the impediment varies according to 
the nature of the involvement. 

Following protracted cases of labor in some instances where 
only a unilateral paralysis exists, walking is perfoi-med with 
difficulty; the subject may lie unable to support weight with the 
affected member and is obliged to hop cm the one sound hind leg. 
In bilateral affections, they are nnable to rise. If the condition 
is severe the sling is required to keep the subject standing, and 
with this care, recovery will follow. 

Treatment. — If new growths or callosities or similar condi- 
tions aff'ect the nerve, little, if any, hope for recovery exists. In 
young and vigorous subjects where cause is not definitely known, 
a course of strychnin may be given. Clood nursing, ])i-oviding 
for the subject's comfort and allowing moderate exercise, consti- 
tute rational treatment. Stimulating embrocations on the ab- 
ductor muscles resorted to in cases during the incipient stage 
may prove helpful. 

"When paralysis of the obturator nerve occurs as a post-partum 
complication, and otlier conditions are favorable, the subject 
should be raised to its feet without unnecessai-y delay. If the 
mare is unable to assist in regaining her feet, a sling is re(|uii-ed. 
Usually little else is necessary and after a few days in the sling 
the subject can get about unassisted. In the meanwhile the 
well-being of the affected animal is to be considered just as in 
any other case where the patient is so confined. The foal in 



208 LAMENESS OF THE HORSE 

such instances constitutes a source of some trouble, but the aver- 
age mare offers no serious resistance to the confinement occa- 
sioned by the sling. 

Good hygienic care, a suitable diet and full physiological doses 
of strychnin are indicated. Cadiot and Almy recommend vaginal 
douches of cold water and counterirritation of the region of the 
inner thigh in these cases. 

Paralysis of the Sciatic Nerve. 

Anatomy. — The great sciatic nerve leaves the pelvis in com- 
pany with the gluteal nerves, through the great sciatic foramen 
(notch), passing downward along the posterior face of the fem.ur. 
Near the stifle it passes between the two heads of the gastroc- 
nemius muscle and continues as the tibial. Branches supply 
the following muscles — obturator, semimembranosus (adductor 
magnus), biceps femoris (triceps abductor femoris), semitendi- 
nosus (biceps rotator tibialis), lateral extensor (peroneus) and 
the tibial nerve, its continuation, innervates the digital flexors. 

Etiology and Occurrence. — Paralysis of the great sciatic 
nerve may be caused by central disorders, injury in falling, frac- 
tures and new growths. Because of its protected position, this 
nerve does not often suffer injury, and paralysis of the sciatic 
nerve is recorded in a few instances owing to its rarity. 

Symptomatology. — When consideration is given the number 
of muscles that are supplied by the sciatic nerve and the func- 
tion of these muscular structures, it is obvious that the leg 
cannot be used in sciatic paralysis. However, the limb is 
capable of sustaining weight when it is fixed in position, but this 
is done without exertion of muscular fibers which are supplied 
by the great sciatic nerve. Trotting is impossible and flexion 
of the affected member is also likewise precluded. The foot is 
dragged when the subject is caused to advance. 

Under the heading ''sciatica," Scott^ has described a case of 
acute sciatic affection wherein a pacing horse manifested evidence 
of great pain of a nervous character. There were muscular 

^Dr. John Scott, Peoria, 111., in The American Veterinary Review, Vol. 16, 
page 16. 



[LAMENESS IN THE HIND LEG 209 

twitcliings and the leg was held oft' the tioor and moved about 
convulsively. Breathing was very much accelerated, pulse 85 
per minute, the temperature was 103° and manipulation of the 
hips augmented the pain. 

This was not a paralytic condition and recovery resulted, yet 
undoubtedly this was a pase which, if not properly cared for, 
might have terminated unfavorably. 

Treatment. — Prognosis is decidedly unfavorable in paraly- 
sis of the great sciatic nerve. If treatment is attempted, it is 
to be conducted along the same general lines as in femoral 
paralysis. Particular attention should be given to conditions 
which will make for the patient's comfort, and as soon as it 
is evident that the affection is not progressing favorably, the 
subject should be humanely destroyed. 

Iliac Thrombosis. 

This condition is undoubtedly of more frequent occurrence 
than we are wont to grant when one considers the comparatively 
small number of cases that are actually recognized in practice. 
It does not follow, however, that iliac thrombosis rarely exists. 
Probably in the majority of instances there is insufficient obstruc- 
tion of the lumina of vessels to provoke noticeable inconvenience. 
Or, if circulation is hampered to the extent that function is 
impaired and manifestations are observed by the driver, the 
subject may be permitted to rest a few days and partial resolu- 
tion occurs, so that further trouble is not noticeable. 

As judged by lesions of the aorta and iliac arteries in dissect- 
ing subjects, the conclusion that arteritis and resultant disorders 
are of rather frequent occurrence, is logical. 

Etiology. — Inflammation of the vessel walls and resultant 
prolifieration of tissue together with the accumulation of clotted 
blood becoming organized, serve to obstruct the lumen of the 
affected artery. The cause of arteritis is unknown in many 
instances, but parasitic invasion and contiguous involvement of 
vessels in some inflammatory injuries are etiological factors. 

Symptomatology. — A characteristic type of lameness sig- 
nalizes iliac thrombosis and the following brief abstract from a 



210 LAMENESS OF THE HORSE 

contribution on tliis subject by Drs. ^lerillat^, clearly portrays 
the chief symptoms : 

The seizures are accompanied with profuse suclation, tremors, 




Fig. 48 — Exposure of aorta and its branches, showing location of thrombi in 
numerous places. In this case (same as Fig. 49) Dr. L. A. and Dr. Edward 
Merillat found the cause of the condition to be due to sclerastomiasis. 

dilated nostrils, accelerated respirations and otlier symptoms of 
pain and distress, all of wliich, together with the lameness, dis- 
appear as rapidly as they had developed, leaving the animal in 

^Annotation on Surgical Items, by Drs. L. A. and Edward Merillat, Ameri- 
can Veterinary Review, Vol. 31, page 358. 



■LAMENESS IN THE HIND LEG 



211 



;in ai)i)ai-eutly i)erl'ect state of healtli, ready to fall with another 
attack of precisely the same kind, as soon as enough exercise is 
forced upon it. The rectal explorations may reveal a pulseless 
state of one or more of the iliac arteries and a hardness and 
enlargement of the aortic (juadrifurcation, but sometimes this 
palpation fails to disclose any perccpfible diminution of the blood 
current of these vessels. The obturation being incomplete, it 
may be impossible by palpation to decide that thrombosis really 




Fig. 49 — Illustrative of ihionibosis of the aorta, iliacs and branclie.s. riiotd 
by Dr. L. A. Merillat. 



exists. In this event and, in fact, in all cases, the clinical symp- 
toms are sufficiently characteristic to make a diagnosis without 
reservation. It cannot be mistaken for any other disease, once 
properly investigated. Any given seizure may easily be mis- 
taken for azotnria, at first, but a better examination soon ex- 
cludes that disease. 

Prognosis and Treatment. — In the majority of instances, 
when there is occasioned serious inconvenience, the outcome is 
not likely to be favorable, according to ^Moller. Detachment of 
a portion of the thrombus, according to Iloare, may result in 
the lodgment of an embolus in tlie brain or kidneys. The latter 
authority also states that muscular atrophy may occur owing to 
lack of lilood supply in some of these cases. Moller states that 



212 LAMENESS OF THE HORSE 

moderate exercise or work stimulates the establishment of col- 
lateral circulation. Massage per rectum is condemned as danger- 
ous by Cadiot. 

Fracture of the Patella. 

Etiology and Occurrence. — Patellar fractures are rarely met 
with in the horse but may be caused by falls and heavy con- 
tusions. Violent muscular contraction, it is said, may also bring 
about the same condition. 

Symptomatology. — Fracture may be transverse or vertical, 
and depending on the manner in which the bone is broken, prog- 
nosis is either at once rendered favorable or unfavorable. The 
patella performs a function which is in a w^ay similar to that 
of the sesamoids and w^lien fractured, complete recovery is im- 
probable in the average instance. "When complete, transverse 
fractures permit of separation of the parts of bone. Tension on 
the straight ligaments below and contraction of the quadriceps 
above usually cause insuperable difficulty in the handling of this 
type of fracture in the horse. 

Compound fractures as well as multiple or comminuted frac- 
tures occasionally occur and these constitute injuries which are 
generally considered fatal, although Andrien, according to Cadiot 
and Almy, succeeded in obtaining complete recovery in a case of 
compound fracture of the patella and the horse was in service 
and almost free from lameness two months after treatment was 
'begun. 

No difficulty is encountered in recognizing the fracture of the 
patella because of the exposed position of the bone. Crepitation, 
and in some cases fissures, may be easily detected. 

Treatment. — In simple fracture, when treatment is thought 
advisable, the subject is put in a sling and kept as nearly com- 
fortable as possible. If little inflammation exists, the application 
of a vesicant two or three weeks after the injury has been in- 
flicted will be helpful and serve to hasten repair. 

Bandages or mechanical appliances are of no practical use in 
the handling of these cases. 



LAMENESS IN THE HIND LEG 213 

Luxation of the Patella. 

Etiolog-y and Occurrence. — This, the most coniiiiou luxation 
met with in the equine subject, has been described by writers 
as existing in many forms. Patellar disarticulation may be more 
practically considered as momentary and fixed, regardless of the 
position taken by the patella. Described under the title of false 
luxation are recorded cases wherein the quadriceps (crural) 
muscles become contracted in such manner that a condition simu- 
lating true disarticulation of the patella obtains. Also, some 
practictioners report cases of patellar luxation and refer to 
pseudo-luxations, without clearly defining the conditions which 
constitute pseudo-luxation. This has contributed to the extant 
cause of misconception as to actual differences between luxation 
and conditions simulating dislocation. 

Luxation of the patella is a condition wherein the articular 
portions of the femur and patella assume abnormal relations 
whether such displacement of the patella be momentary and 
capable of spontaneous reduction, or fixed and requiring cor- 
rective manipulation. Spasmodic contraction of the crural mus- 
cles which sometimes retains the patella in such position that 
the leg is rigidly extended, does not in itself constitute luxation 
of the patella ; and unless this bone becomes lodged on the upper 
portion of a femoral condyle or laterally displaced out of its 
femoral groove, luxation cannot be said to exist in the horse. 
These are sub-luxations. 

Occasionally one may observe in suckling colts outward luxa- 
tion of the patella wherein there is history of navel infection 
and no marked evidence of racliitis is present. Some of these 
cases recover. In a imilateral involvement of this kind in a 
three-month-old mule colt, the author observed a case wherein 
an unfavorable prognosis was given and destruction of the sub- 
ject advised, because of the extreme dislocation of the patella. 
This colt, however, was not destroyed and in three weeks had 
apparently recovered. No treatment was given in this instance ; 
the colt was allowed the run of a small pasture with its dam and 
in time it matured, becoming a sound and serviceable animal. 

Classification. — Two forms of true patellar luxation in the 



214 LAMENESS OF THE HORSE 

horse nia}^ be considered; one wliieli is due to the patella becom- 
ing fixed upon the internal trochlear rim of the femur and the 
other when the patella slips over the outer rim of the trochlea. 

The first form is known as upward luxation and is made pos- 
sible bj^ rupture of the mesial (internal) lemeropatellar ligament. 
According to Cadiot and Almy, it is only by the rupture of 
this ligament — the femeropatellar — that upward luxation may 
occur. This type of luxation is rarely observed and is usually 
due to violent strain and abnormal extension of the stifle joint. 

The second class, outward luxation, occurs in colts and is, 
in many instances, congenital. This form of luxation is also 
the one usually seen following debilitating diseases such as influ- 
enza and pneumonia. 

Upward luxation of the patella is characterized l)y the stiff- 
extended position of the leg. When the patella is situated 
upon the inner trochlear rim, the tibia luust be extended because 
of the traction exerted by the straight ligaments. Since the 
stifle and hock joints extend and flex in unison, there is presented 
also an extension of the tarsus. Extension of the stifle joint 
would increase the distance between the femoral origin of the 
gastrocnemius and its insertion to the summit of fibular tarsal 
bone (calcis) were it not for the gastrocnemius and superficial 
flexor (perforatus). Extension of the hock in upward luxation 
of the patella, permits of flexion of the phalanges. In upward 
luxation, then, the leg is extended as if too long, but the pha- 
langes may be in a state of moderate flexion. If the foot rests on 
the ground when the extremity is not flexed, it is almost impossi- 
ble for the subject to step backward. Because of immobilization 
of the stifle and hock joints in upward luxation, the subject can 
walk only by hopping on the sound leg and then the extremity 
is flexed, allowing the anterior portion of the fetlock to drag on 
the ground. 

In some cases practitioners are called to attend young animals 
that are reported to be "stifled" (often in young mules that 
have made a rapid growth) and upon arrival the only noticeable 
symptom of preexisting luxation is the soiled condition of the 
anterior fetlock region — evidence of its having been dragged. 
Such cases, may be styled momentary luxation, whether they are 



LrAMENESS IN THE HIND LEG 215 

due to a weakened eonditiuu of tiie patellar ligameuts or spas- 
iiiodie eontraction of the crural muscles. 

Ill upward luxation, reduction is effected by attempting fur- 
ther extension of the stitle joint and at the same time the patella 
is pulled outward, off the internal rim of the trochlea. This is 
attempted by securing the subject in a standing position; the 
sound side is kept against a wall if possible and a rope is tied 
to the extremity of the affected leg. Traction is exerted upon 
the rope and at the same time force is directed against the stifle 
joint to produce further extension if possible, so that the straight 
patellar ligaments may relax sufficiently to allow the patella to 
be dislodged from its i)Ositioii upon the inner trochlear lip. Fail- 
ing in this manner of j)rocedure, the affected animal is to be 
cast and anesthetized with chloroform. The relaxation which 
attends surgical anesthesia will permit of reduction of the dis- 
located bone and mauipnlations such as have just been outlined 
may be employed. 

Following reduction in the average case it is essential that the 
subject be given vigorous exercise for a few minutes. Reduction 
having been affected, the application of a vesicant over the 
Avhole patellar region is customary. 

In cases of habitual luxation, unless the ligaments are so lax 
that the patella may be displaced laterally over the inner as 
well as the outer trochler rims, division of the inner straight 
patellar ligament will correct the condition. This desmotomy 
has been advocated by Bassi, and good results in appropriate 
cases have lieen reported by Cadiot, Merillat and Schumacher. 
This operation has ))een found a corrective in eases of outward 
luxation as well as those of upward dislocation of the patella 
when resorted to before the trochleae are Avorn from frequent 
luxation. 

Outward luxation of the patella is occasioned by a lax condi- 
tion of the internal femeropatellar ligament or a rupture of the 
same so that the patella slips over the outer femoral trochlear 
rim and permits of an abnormal flexion of the stifle joint. The 
outer trochlear rim being the smaller of the two, inward luxation 
does not occur in the horse. With the patella disarticulated in 



216 LAMENESS OP THE HORSE 

this manner, the action of the quapriceps femoral group of 
muscles has no effect on the stifle joint and, therefore, flexion of 
this articulation occurs as soon as the subject attempts to sustain 
weight and the leg collapses unless weight is at once taken up by 
the other member if sound. 

As a rule, the "reduction of this form of luxation is not diffi- 
cult. The patella may be pushed inward and into position with- 
out manipulation of the leg. Retention of the patella in position 
is a difficult problem. Bandaging is considered impractical and 
is not ordinarily done in this country. Benard, according to 
Cadiot and Almy, recommends bandaging with a heavy piece of 
cloth in which an opening is made through which the patella 
is allowed to protrude, and by turning such a bandage snugly 
about the stifle several times, the patella is held in position. This 
bandage should be kept in place for about ten days. 

In young and rachitic animals outdoor exercise and a good 
nutritive ration for the subject are indicated. Hypophosphites 
in assimilable form may be beneficial, and vesication of the pa 
tellar region contributes to recovery. 

Where extreme luxation is present in both stifles, the prog- 
nosis is unfavorable. In such cases, degenerative changes may 
exist and in some instances the ligaments are so diseased and 
elongated that regeneration is impossible. Williams^ reports a 
case where bilateral "floating" (outward) luxation was present 
and extensive degeneration changes affected the articulation. 

In subjects suffering frequent dislocation of the patella (ha- 
bitual luxation) it is possible in some cases, to prevent its occur- 
rence or at least to minimize the distress occasioned by momen- 
tary luxation, by keeping the animals in wide stalls so that 
"backing" is unnecessary. In some nervous subjects that seem 
to be suffering from cramp of the crural muscles, the difficulty 
and pain of their being backed out of narrow stalls, accentuates 
the nervousness. Sudation and restlessness are manifested and 
the subject presents a clinical picture of distress and fear of a 
painful ordeal. In some cases of this kind, complete recovery 
takes place by the time animals are five or six years of age. 
One should avoid keeping such subjects in narrow stalls. Pref- 



iW. L. "Williams in American Veterinary Review, Vol. 21, page 452. 



LAMENESS IN THE HIND LEG 217 

erably patellar desmotomy should be performed that relief may 
be obtained at once. 

Luxations attending some cases of influenza recover promptly 
when subjects are kept comfortably confined in roomy box-stalls. 
The administration of stimulative medicaments such as nux vom- 
ica and the application of an active blistering agent to the 
patella serve to hasten recovery. Dislocations in such cases are 
often bilateral and they are usually momentary. Reduction 
occurs spontaneously, as a rule, and the subjects are not occa- 
sioned much distress if they are kept quiet for a few days. 

Chronic Gonitis. 

Etiology and Occurrence. — Chronic inflammation of the 
stifle joint is met with following acute synovitis due to strains 
and concussion. It is an ailment which affects heavy horses and 
particularly animals that are kept at work on paved streets, but 
this does not explain its existence in animals that are not sub- 
jected to work likely to cause concussion. Berns^ considers rheu- 
matism a probable cause of gonitis and, as he states, the dropsical 
form of affection of this joint is not ordinarily attended with 
manifestations of inconvenience to the subject. Gonitis is often 
bilateral and its onset is insidious in many instances. 

Symptomatology. — In unilateral gonitis weight is not borne 
l)y the affected member. There is noticeable distension of the 
joint capsule — a characteristic pendant pouching protrusion. 
Wlien both stifles are affected the subject frequently shifts the 
weight from one limb to the other. Lameness comes on gradu- 
ally and during the incipient stages may be intermittent but it 
progressively increases so that in time affected animals become 
useless. In bilateral affections animals drag the toes because 
of the pain incident to flexing the stifles. This is particularly 
evident when the subject is made to trot. As the disease pro- 
gresses, atrophy of the quadriceps femoris muscles becomes pro- 
nounced and as destructive changes involving the articular car- 
tilages take place. The subject becomes more lame and eventu- 
ally is rendered incapable of service. 

iQeo. H. Berns, D. V. S., report, American Veterinary Medical Association, 
1912, page 238. 



218 LAMENESS OF THE HORSE 

Upou manipulation of the patellar I'egion, one is impressed 
with the fact that hyperesthesia does not exist in proportion to 
the pain manifested during locomotion. In some cases a gel- 
atinous S'\\elling is present and may he detected by palpating 




Fig. 50 — Chronic gonitis. The knucliling which results from long continued 
inactivity of the crural muscles in chronic cases is marked in this instance. 
Photo by Dr. L. A. Merillat. 

between the straight ligaments of the patella. Williams, Hughes, 
Merillat, Hadley and others have directed attention to the exist- 
ence of floating masses {coypova oryzoidca) in the synovial cap- 
sule of this joint in gonitis, and as with all eases of arthritis, 
irreparable damage is often done the articular cartilages during 
the course of the ailment. 



[LAMENESS IN THE HIND LEG 



219 



Treatment.— No effective method is as yet known which 
will control this condition during its incipiency. The disease 
progresses, and more or less damage is done the affected parts 
in the course of months or even years in some cases before sub- 




Fig. 51 — Gonitis. Showing position assumed in such cases because of pain 
occasioned. Photo by Dr. C. A. McKillip. 



jects arc i-ciKlcred hopelessly crippled. When recognized early 
(l)efore chronic gonitis exists) aspiration of the synovia and the 
injection of diluted tincture of iodin might prove beneficial in 
cases of syn(i\i;il dislciisidu. Chronic gonitis is considered an 
incurable affecticm and as soon as subjects manifest evidence of 
(listi-css from this condition they should by all means be taken 
fi'oiii work. Firing and vesication have not been productive of 
benefieial residts. 



220 LAMENESS OF THE HORSE 

Open Stifle Joint. 

Anatomy of the Joint Capsule. — This joint capsule is thin 
and very capacious. On the patella it is attached around the 
margin of the articular surface, but on the femur the line of 
attachment is at a varying distance from the articular surface. 
On the medial side it is an inch or more from the articular car- 
tilage; on the lateral side and above, about half an inch. It 
pouches upward under the quadriceps fern oris for a distance of 
two or three inches, a pad of fat separating the capsule from the 
muscle. Below the patella it is separated from the patellar liga- 
ments by a thick pad of fat, but inferiorly it is in contact with 
the femerotibial capsules. The joint cavity is the most extensive 
in the body. It usually communicates v/ith the medial sac of 
the femerotibial joint cavity by a slit-like opening situated at 
the lowest part of the medial ridge of the trochlea. A similar, 
usually smaller, communication with the lateral sac of the fe- 
merotibial capsule is often found at the lowest part of the lat- 
eral ridge. (Sisson's Anatomy.) 

Thus it is seen that because of its frequent communication 
with the other parts of this large synovial membrane, a wound 
which opens the external portion of the femerotibial capsule 
may be the cause of contamination and resultant infectious ar- 
thritis of the whole stifle joint. Because of the distance between 
the most dependent part of the femerotibial articulation and 
the summit of the patella, one may misjudge the exact location 
of the lowermost part of this portion of the capsular ligament 
of the stifle joint and thereby fail at once to appreciate the seri- 
ousness of calk wounds in this region. 

Etiology and Occurrence. — -Wounds to the patellar region 
are of rather frequent occurrence, and because of the compara- 
tively unprotected position of these structures, the capsular liga- 
ments of the stifle joint may be perforated as a result of violence 
in some form. Calk wounds which penetrate the tissues in the 
immediate region of the lower portion of the external part of 
the femerotibial capsule sometimes result in open joint because 
of tissue necrosis resulting from the introduction of infection. 
Contused wounds sometimes destroy the skin and fascia over 



LAMENESS IN THE HIND LEG 221 

large areas on tlie lateral patellar region and because of subse- 
quent sloughing of tissue due to infection as well as to the man- 
ner in Avhich sueh wounds are inflicted, septic arthritis subse- 
quently occurs. Penetrant womids, such as may be caused by a 
fork tine may not result in infection ; if infectious material is 
introduced an infectious arthritis does not necessarily follow, 
though such cases should be considered as serious from the out- 
set. 

Symptomatology. — The pathognomonic symptom of open 
stifle joint is the profuse escape of synovia, indicating perfora- 
tion of the synovial capsule ; by means of a probe the wound 
may be explored in a way that will clearly reveal the nature of 
the injury. 

After a few days have elapsed in cases where considerable 
infection has taken place, there is manifestation of pain as in 
all cases of infective arthritis. Hughes^ gives an excellent de- 
scription of the clinical aspect of arthritis which applies here : 

Acute arthritis begins like an ordinary attack of synovitis. 
In joints other than the pedal and pastern, there is sudden and 
extensive swelling, which at first is intra-articular, succeeded by 
extra-articular tumefaction, and accompanied by violent lame- 
ness. The pain soon becomes intense and agonizing. There is 
severe constitutional disturbance, the temperature ranging from 
104 to 106 degrees and the pulse from 60 to 72. Painful con- 
vulsions of the limb occur, shown by involuntary spasmodic ele- 
vations due to reflex irritation of the muscles. There is loss 
of appetite, rapid emaciation, the flank is tucked up and the 
back arched. In from three to six days, the tumefaction around 
the joint tends to soften at a particular place, and bursts, and 
a discharge that is sometimes of a sanious character, mixed with 
synovia, escapes. Great exhaustion at times supervenes, and 
if the joint is an important one. the horse lies or falls and is 
unable to rise. 

Treatment. — In small puncture wounds the immediate appli- 
cation of a vesicating ointment has given good results, but when 
infection has taken place to such extent that the animal mani- 
fests evidence of intense pain, and lameness is marked and local 
swelling and hyperesthesia are great, vesication is contraijuli- 



iJoseph Hughes, M. R. C. V. S., in the Chicago Veteriiiarv College Quar- 
terly Bulletin, Vol. 10, page 15. 



222 LAMENESS OF THE HORSE 

cated. In such instances the exterior of the wound and its mar- 
gins shoukl be prepared as in similar affections of other joints. A 
quantity of synovia is then aspirated by means of a small tro- 
car and care should be taken to observe all due aseptic precau- 
tions. Subsequently the injection of from four to six ounces 
of a mixture of tincture of iodin, one part to ten parts of gly- 
cerin, and gentle massage of the joint immediately after the 
injection has been made, serves to check the infective process 
in some cases. 

The suliject should be cared for as has been previously sug- 
gested in arthritis — proper provisions for comfort being made. 
Good nursing is always essential to a successful issue. However, 
the author cannot view cases of open stifle joint with the same 
optimism concerning their course and outcome that is expressed 
by a number of writers on this subject. It is a grave condition 
wherein the prognosis should be given advisedly. 

Fracture of the Tibia. 

Etiology and Occurrence. — Because of its exposed position 
to kicks, and its lack of protection by heavy musculature (espe- 
cially on its inner surface), there is afforded ample opportunity 
for frequent injury to the tibia. Fractures are complete and 
varying as to nature, or incomplete. The heavy tibial fascia 
affords sufficient protection so that fissures without entire solu- 
tion of continuity of the bone may occur from violence to which 
this part is often subjected. Moller classes tibial fracture as 
ranking second in frequency — pelvic fracture being more often 
met with in horses. This does not apply in our country as pha- 
langeal and metacarpal and even metatarsal fractures are ob- 
served in more instances than are such injuries to the tibia. The 
tibia is occasionally broken at its middle and lower thirds, but 
malleolar fractures are not common. 

Symptomatology. — When fracture is complete and all sun- 
port is removed, the leg dangles, and the nature of the injury 
is so obvious that there is no mistaking its identity. However, 
in case of incomplete fracture one needs to base all conclusions 
upon the history of the case, evidence of injury, or other knowl- 



LAMENESS IN THE HIND LEG 223 

edge of the eluiracter of violence to which this bone has l)een 
exposed. For without the presence of crepitation (even by ex- 
clnding other possibh- causes for the pronounced lameness which 
cliaractcrizes some of these cases) we can only resort to the 
knowledge whieli experience has taught that fracture may be 
deemed probalile in many injuries to the tibial region. Con- 
sequently, we are to look upon all injuries that affect the tibia 
as being fractures of some sort when there is either local evidence 
of the infliction of violence or whenever marked lameness attends 
such injuries, unless there is positive indication that no fractures 
exist. 

A careful examination of parts of the tibia, i. e., noting the 
amount and painfulness of swellings, exploration with the probe, 
and observations of the course taken in any given case, will 
determine the exact nature of injuries. Such examination needs 
to extend over a period of a week or in some instances two or 
three weeks may pass before the true state of affairs is apparent. 
In the meanwliile, cases are to be handled as though tibial frac- 
ture certainly existed. 

Prognosis. — Prediction of the outcome in tibial fracture is 
somewhat presumptuous, but in the majority of cases in mature 
sulijects fatality results. Cadiot\ however, views this condition 
witli more optimism than have American practitioners. AMiile 
he considers the condition grave, in citing case reports of suc- 
cessful treatment by d'Arboval, Diichemin, Leblanc, and others, 
his conclusion is that many practitioners erroneously consider 
fractures of the tibia as incurable. 

The method of handling these cases by Leblanc is as follows : 
The subject is placed in a sling; a pit is excavated below the 
affected member so that a heavy weight may be attached to the 
extremity; splints are applied to each side of the leg, Avhich is 
padded with oakum, and this is kept in position by means of 
bandages covered with iiitch. The outer splint extends from 
the hoof to the stifle and tlie inner one from the hoof to the 
upiier third of the leg. This method in the hands of Leblanc 
has ])ecn successful in several instances, according to Cadiot, 

'Tralte cle Therap. Chir. Cadiot et Almy, Tome second, page 480. 



224 LAMENESS OF THE HORSE 

In a foal the author has in one instance succeeded in obtain- 
ing complete recovery in a simple fracture of the lower third 
of the tibia where the only support given the broken bone was 
a four-inch plaster-of-paris bandage which was adjusted above 
the hock. Below the tarsus a cotton and gauze bandage was ap- 
plied to prevent swelling of the extremity. In this instance 
(an emergency case in which materials that are not to be recom- 
mended were necessarily employed) recovery took place within 
thirty days. 

As has been mentioned in the consideration of radial frac- 
tures, heavy leather is better suited for immobilization of these 
parts than a cast or other rigid splint materials. Mature ani- 
mals may be expected to resist the immobilization of the hind 
legs because of the normal manner of flexion of the tarsal and 
stifle joints in unison. Therefore, the application of rigid splints 
to the leg and including the hock is productive of disastrous 
results in some cases. 

The application of cotton and bandages to pad the mem1)er 
and the adjusting of heavy leather splints on either side of the 
leg, and retaining them in position with four-inch gauze band- 
ages will prove more nearly satisfactory than some other meth- 
ods employed. Prognosis is unfavorable, however, in most cases 
of compound fracture and recovery is improbable when the 
upper portion of the tibia is broken. 

Rupture and Wounds of the Tendo AchilHs. 

Etiology and Occurrence. — Cases are recorded by Uhlrich 
in which rupture has followed degenerative changes affecting 
the tendo Achillis. Not infrequently, the result of a trauma, 
division of the tendo Achillis occurs. jMoller states that rupture 
of this tendon may be due to jumping, in riding horses and in 
draught horses, in their efforts to avoid slipping. In runaways, 
it sometimes occurs where sharp-edged implements are bounced 
against the legs in such fashion that division of the tendon re- 
sults. 

Symptomatology.— 'AVith division of the tendo Achillis or 
of the musculature of the gastrocnemii and the superficial flexor 



LAMENESS IN THE HIND LEG 225 

(perforatus), there remains nothing to inhibit tarsal flexion 
except tlie deep flexor tendon (i)erforans) and this does not sup- 
port the leg. When attenijit is made to sustain weiglit with the 
affected member, abnormal flexion of the tarsus takes place and 
the hoek sinks almost to the ground. The symptoms are so char- 
acteristic that recognition is always easy even in case no wound 
of the skin exists. 

Prognosis. — Spontaneous recoveries occur and such cases 
are reported by Bouley who is quoted by Cadiot as having ob- 
served division of the tendo Achillis due to a sword wound 
wherein at the end of four months recovery was complete. Di- 
vision of this tendon in brood mares has been practiced by the 
early settlers of parts of the United States for the purpose of 
preventing their straying too far from home. In such instances 
one leg only was so mutilated and in most instances, it is re- 
ported that spontaneous recovery took place. 

In unilateral involvement without complications, the prog- 
nosis is not unfavorable if provisions for giving necessary atten- 
tion are available. 

Treatment. — The subject is to be confined in a sling and the 
member bandaged and supported by means of leather splints. 
Immobilization as for fracture is not necessary but, nevertheless, 
movement is to be restricted as much as possible. In case of 
open wounds, the exposed tissues are cared for along general 
surgical lines. Where the divided parts of the tendon are main- 
tained in fairly close and constant relation, granulation of tissue, 
sufficient to sustain weight takes place in from six weeks to three 
months. 

Spring-Halt. ( String-Halt. ) 

Occurrence. — This condition is a myoclonic affection of the 
hind leg which is discussed in works on theoiy and practice 
under the head of neuroses, but the cause or causes have not 
been established. Theories that heredity is responsible have 
their supporters and advocates of hypotheses attributing it to 
disease of the sciatic nerve, patellar subluxation, fascial con- 
traction of various muscles, "di-y spavin" (tarsal arthritis), 
iliac exostoses, disease of the foot and contraction of the hoof, 



226 



LAMENESS OF THE HORSE 



are on record in veterinary literature. This ailment affects old 
horses more frequently than it does young and is seen in all 
breeds of animals including mules. 

Symptomatology. — This disease develops slowly, and pro- 
gressively increases in severity as a rule, but does not ordinarily 




Fig. 52— Spring-halt. 

constitute cause for rendering an animal unserviceable. "While 
the affection is sometimes bilateral (occasionally affections of 
the forelegs are reported) and the extreme flexion of the legs 
in the spasmodic manner which characterizes spring-halt, cause 
great waste of energy during locomotion, yet such cases are 
rare. Usually the ailment is markedly evinced when subjects 
are first taken from the stable, but as they are exercised the 
manifestation diminishes, and in many instances it completely 
subsides. The condition is generally more noticeable when the 
subject is made to step backward. In some animals there is 



ILAMENESS IN THE HIND LEG 227 

marked abduction at the time flexioa occurs and in singular 
instances tlie spasmodic contraction is so violent that the subject 
falls to the ground as a result of the peculiar flexion of the leg. 
In severe cases of "scratches" or chemical irritation of the 
extremity, the legs are abnormally flexed in a manner which 
simulates spring-halt, but because of the evident injury of the 
parts this is not likely to confuse. Since all facts concerning 
etiological agencies are surrounded with so much oliscurity, clas- 
sification does not lend any particular assistance in the consid- 
eration of this ailment. 

Prognosis. — One cannot intelligently give a prognosis in 
these cases if forecast is expected to state the exact course fol- 
lowing treatment. However, in a general way, cases of recent 
affection are thought more favorable than are those of long stand- 
ing or in old animals where myositis and other muscular and 
fascial affections exist owing to years of hard service. 

Treatment. — No known line of medicinal treatment is of 
service, nor is any particular surgical operation to be considered 
dependable for obtaining relief. Operations of almost every con- 
ceivable nature have been tried with the hope of securing recov- 
ery in spring-halt but under no condition can the practitioner 
as yet be reasonably certain of effecting permanent relief in any 
case. Treatment is, therefore, entirely empirical. 

Neurectomies have been performed and recoveries following 
were attributed thereto ; fascial divisions in the crural region 
have been done with good results and this manner of treatment 
has its favorers. Advocates of tenotomies, likewise, are to be 
found. Consequently, one may summarize thus : Spring-halt is 
a disease of unknown origin — the exact cause has not been deter- 
mined; therefore, all treatment is, in a way, experimental. The 
recommendation of any given procedure in handling cases must 
then be a matter of opinion based either upon practical experi- 
ence or knowledge of the experiences of others. Divisions of the 
lateral digital extensor (peroneus) below the tarsus near its 
point of insertion to the extensor of the digit is recommended 
here because it is followed by a percentage of recoveries that is 
as large as in any other method of treatment and the operation 



228 



LAMENESS OF THE HORSE 




Fif. 53 — Lateral (external) view of tarsus showing effects of generalized 
tarsitis. 



LAMENESS IN THE HIND LEG 229 

is not difficult to perform nor is its pcit'orniance fraught with 
SLuy dangerous complications. In selected subjects about fifty 
per cent of cases recover in from two to six weeks following this 
operation. 

Open Tarsal Joint. 

Like the ti])ia the hock is exposed to frequent injuries and in 
some cases wonnds perforate the joint capsnle. When due to 
calk wounds where horses are kicked, the injury is often on the 
side of the tarsus (medi^d or lateral) and such Avonnds not in- 
frequently result in infectious arthritis. Horses sometimes jump 
over wire fences and wounds are inflicted which constitute ex- 
tensive laceration of the joint capsule. In firing for bone spavin, 
where a deep puncture is made very near the tibial tarsal (til)io- 
astragular) joint if infection gains entrance, serious and general- 
ized infection of the open joint cavity supervenes in some cases. 

Symptomatology. — There is no marked difference in the con- 
stitutional disturbances which are occasioned in this condition 
and those encountered in other cases of septic arthritis (previ- 
ously considered herein) except that there is a difference in the 
degree of resultant derangement and local tissue changes. 
Chiefly, l)ecause of the difficulty encountered in keeping the 
hock joint in an aseptic condition or securely bandaged, open 
tarsal joint constitutes a more serious condition than a similar 
affection of the fetlock. Otherwise, a very sinnlar condition ob- 
tains and the same diagnostic principles serve here that have 
been described on page 110 in considering open fetlock joint. 

Treatment. — The same plan that is described in detail for 
treatment of similar conditions affecting the fetlock joint is indi- 
cated in this affection. Exceeding care must be exercised in 
l)andaging the hock, however, lest the animal be so irritated that 
in the extreme flexion of the tarsus which is often caused l)y 
bandaging, the wound dressings may be completely deranged. 
A wide gauze bandage material is most satisfactory; cotton of 
long fiber is separated in thin layers and wound about the hock, 
extending from the site of injury to a point about six inches 
proximal to the summit of the os calcis. By using an abundance 



230 LAMENESS OF THE HORSE 

of cotton in this way, it will not be found necessary to apply the 
bandages very snugly; with a four-inch gauze bandage material, 
which is supported above the cap of the hock and brought across 
the anterior face of the tarsus in a diagonal manner, a comfort- 
able and very serviceable protective dressing is provided for. 
Animals so treated will not ordinarily resist because of pressure 
from the bandages. Pressure is unavoidable in the use of ad- 
hesive dressings or where careful attention is not given the man- 
ner of applying cotton to the parts. Such methods are sure to 
result disastrously^ But if .subjects are kept quiet after the 
parts have been properly bandaged, no difficulty is encountered 
in maintaining asepsis in an uninfected wound. Recovery takes 
place in favorable cases in from three weeks to three months, de- 
pending on the nature and extent of injuries inflicted. 

Fracture of the Fibular Tarszil Bone ( Calcaneum. ) 

Etiology and Occurrence. — This condition though rarely met 
with in the horse, is the result of violent strain upon the os 
calcis by the gastrocnemius and superficial flexor tendons in 
efforts put forth by animals in attempts to regain a footing when 
the hind feet slip forward under the body, or in jumping and 
in falls or direct contusion by heavy bodies. Hoare^ reports a 
case of a mare that had produced fracture in jumping. 

Fracture of the other tarsal bones are very seldom observed 
but may be occasioned by contusions wherein multiple or com- 
minuted fractures are produced, such as are to be seen in small 
animals. Fracture of the tibial tarsal bone (astragalus) is to be 
observed as a complication in luxations of the tarsal joint and, 
according to Cadiot, the other tarsal bones may likewise suffer 
fracture in luxations of the hock. 

Symptomatology. — Great pain attends this accident accord- 
ing to the observations given in recorded cases. In the case 
cited by Hoare the animal evinced great pain and uneasiness ; the 
hock was unduly flexed; the calcaneum was displaced forward; 
and marked crepitation w^as present. A portion of the body of 



IE. V^^allis Hoare, F. R. C. V. S., American Veterinary Review, Vol. 27, 
page 1189. 



LAMENESS IN THE HIND LEG 



?31 



the calcaneum was protruding through the perforated skin. The 
animal was destroyed and the bone was found broken in three 
pieces. 

Since the support for the tendo Aehillis is removed in such 



Tuber calcis 



Lalcral niallcol 



Short lateral ligament 



Trochlea of tibial tarsal 
bone 




Short medial ligajtients 



Fig. 54— Right hock joint. Viewed from the front and slightly laterally 
after removal of joint capsule and long collateral ligaments. T. t., Tibial 
tarsal bone (distal tuberosity). T. c, central tarsal bone. T. 3. Ridge of 
third tarsal bone. T. f. Fibular tarsal bone (distal end). T. 4. Fourth tarsal 
bone. Mt. Ill, Mt. IV. Metatarsal bones. Arrow points to vascular canal. 
(P>om Sisson's "Anatomy of the Domestic Animals.") 

fracture and no leverage on the metatarsus obtains, it naturally 
follows that any attempt to sustain weight must result in extreme 
flexion of the hock and descent of this part in a manner similar 
to cases of rupture or division of the Achilles' tendon. The two 
conditions should not be confused, however, as the parts may be 



232 LAMENESS OF THE HORSE 

definitely outlined by palpation and the slack condition of the 
tendon and displaced snmmit of the calcaneuni, which charac- 
terize fracture of the fibular tarsal bone, are easily recognized. 
Treatment. — Prognosis is unfavorable in the majority of 
cases, but should attempts at treatment be undertaken in young 
and quiet mares which might prove valuable for breeding pur- 
poses in case of imperfect recovery, they should be put in slings 
and the member is to be immobilized as in tibial fracture. Au- 
thorities are agreed that prognosis is entirely unfavorable in 
mature animals, when the case is viewed from an economic stand- 
point. 

Tarsal Sprains. 

Etiology and Occurrence. — The hock joint is often subjected 
to great strain because of the structural nature of this part and 
its relation to the hip as well as the manner in which the tarsus 
functionates during locomotion. That ligamentous injuries ow- 
ing to sprain frequently occur and attendant periarticular in- 
flammations with subsequent hypertrophic changes follow, is a 
logical inference. Fibrillary fracture of the collateral ligaments 
may take place in falls or when animals make violent efforts 
to maintain their footing on slippery streets. In expressing 
opinions concerning the frequency with which the hock is found 
to be the seat of trouble in lameness of the pelvic members, dif- 
ferent writers place the percentage of hock lameness at from 
seventy-five to ninety per cent. And when one considers the 
possibility that a goodly proportion of cases of tarsal exostis are 
the outcome of sprains, the occurrence of tarsal sprains may be 
more generally admitted. 

Symptomatology. — A mixed type of lameness is present and 
the nature of the impediment varies, depending upon the loca- 
tion of the injury. Sprains of the mesial tarsal ligaments cause 
lameness somewhat similar to that of spavin. However, in es- 
tablishing a diagnosis, local evidence in these cases is of greater 
significance than the manner of locomotion. During the acute 
stage of inflammation there is to be detected local hyperthermia, 
some hyperesthesia and a little swelling. Later, when resolution 
is not prompt, considerable swelling (or perhaps correctly speak- 



LAMENESS IN THE HIND LEG 233 

mg, an indurated enlargonient) varia])le in size is developed. 
Tn some cases the entire tarsal region becomes greatly enlarged 
and this swelling is very slowly absorbed in part or completely. 
Such sub-acute eases are observed during the winter season and 
particularly where subjects are kept in tie stalls without exercise 
for weeks at a time. 

Treatment.— Attention should be directed toward relief for 
the animal in all acute inflammations. Local applications of 
heat are helpful and, of course, rest is essential. Towels that 
are wrung out of hot Avater and held in position by means of a 
few turns of a loose bandage and this covered Avith an imper- 
vious rubber sheet, will serve as a practical means of application 
of hydrotherapy. Following this when conditions improve, as 
in the handling of all similar cases, counterirritation is indi- 
cated. 

"When proper care is given at the onset and where injury does 
not involve too much ligamentous tissue, recovery takes place 
in a few weeks l)ut in some cases which occur during the winter 
season in farm horses, complete recovery does not result until 
several months have passed. 

Curb. 

The hock is said to be curbed when the normal appearance, 
viewed from the side, is that of bulging posteriorly at any point 
between the summit of the calcaneum and the upper third of 
the metatarsus. Among some horsemen a hock is said to be 
"curby" whenever there exists an enlargement of any kind on 
the posterior face of the tarsus whether it be due to sprain, 
exostosis or proliferation of tissue as a result of contusion. 

French veterinarians consider under the title of "courbe," an 
exostosis situated on the mesial side of the distal end of the tibia. 
Cadiot and Almy state that this condition (courbe) is of rare 
occurrence. Percivall defines curb as "a prominence upon the 
back of the hind leg, a little below the hock, of a curvilinear 
shape, running in a direct line downwards and consisting of 
infusion into, or thickening of. the sheath of the flexor tendons." 
IMoller's version of true curb is a thickening of the plantar liga- 
ment (calcaneocuboid or calcaneometatarsal). Hughes and INIer- 



234 LAMENESS OF THE HORSE 

illat consider curb as a synovitis having for its seat the synovial 
bursa which is situated between the superficial flexor tendon 
(perforatus) and the plantar ligament. 

Occurrence. — Certain predisposing factors seem to favor the 
occurrence of curb. A malformation of the inferior part of the 
tarsus so that its antero-posterior diameter is considerably less 
than normal is a contributing cause. Such hocks are known as 
"tied-in." Another fault in conformation is the existence of a 
weak hock that is set low down on a crooked leg, especially when 
such a member is heavily muscled at the hip. Given such con- 
formation in an excitable horse, and curb is usually produced be- 
fore the subject is old enough for service. It is certain that in 
cases where conformation is bad, greater strain is put upon the 
plantar ligament. This structure serves to bind the tibial tarsal 
(calcis) bone to the metatarsus; traction exerted upon its sum- 
mit hy the tendo Achillis is great when animals run, jump or 
rear and also at heavy pulling. In animals having curby hocks, 
sprain is likely to result and curb supervenes. 

Symptomatology. — The characteristic swelling whicli marl-^s 
curb may develop quickly and lameness occur suddenly or the 
enlargement comes on gradually and slowly, causing little lame- 
ness. Lameness is not proportionate to the size of the swelling 
and in all cases whether subacute or chronic, the condition im- 
proves with rest, but lameness is again manifested xwou exertion. 
A horse which "throws a curb" will go lame until the acute 
inflammatory condition subsides and depending upon treatment 
received and conformation of the hock, this requires from three 
days to two or three weeks. 

The character of the swelling varies ; in some cases it is not 
large but rather dense and lacking in evidence of heat and 
hyperesthesia; in other cases there is considerable swelling, which 
is hot and doughy, somewhat painful to the touch but not neces- 
sarily productive of much lameness. In any event, whether the 
swelling or enlargement is big or little, its location makes it 
conspicuous when viewed in profile. 

In most cases after the acute inflammatory period has passed, 
lameness is slight, if at all present, and in time no interference 



LAMENESS IN THE HIND LEG 



235 



with the suhject's usefulness is occasioned liecause of the curb, 
but the animals often remain l)lemishe(l — complete resorption 
of inflammatory products lieing unusual when much disturbance 
has existed. 

Treatment. — Tlie handling- of curl) during- tlie acute inflam- 
matory stage is along the same lines as in sprain — local applica- 




Fig. 55 — Spavin. 

tions of cold and heat. Sul)jects must be kept quiet until all 
inflamnuition has subsided, for there are no cases wherein a 
little l)risk exercise is more likely to cause a recurrence of lame- 
ness before recovery is complete than in curb. Vesication is in 
order in a week or ten days after the aflfection has set in ; in old 
stubborn cases that have resisted ordinary treatment for a few 
months, the use of the actual cautery (line firing) is to be recom- 
mended. 

Spavin. (Bone Spavin.) 
This term is applied to an affection of the tarsus which is usu- 
ally characterized by the existence of an exostosis on the mesial 



236 LAMENESS OF THE HORSE 

and inferior portion of the hock. There is also included under 
this name, articular inflammation wherein no external evidence 
is shown. Spavin lameness has long been recognized and much 
has been written upon this subject. Since authorities are agreed 
that most cases of lameness in the hind leg are due to hock 
affection, and because the majority of cases of lameness which 
have the tarsal region as the seat of trouble are instances of spa- 
vin lameness, this disease merits all the attention it has received. 

Etiology and Occurrence. — Causes may well be classified as 
predisposing and exciting, for there are many etiologic factors 
to be reckoned with in spavin, some of which are widely different 
in nature. 

Considered as predisposing causes, hereditary influences play 
an important role and may, owing to faulty conformation, sub- 
ject an animal to affections of this kind because of dispropor- 
tionate development of parts (weak and small joints and heavy 
muscular hips) ; or as a consequence of inherited traits, a sub- 
ject may manifest susceptibility to degenerative bone changes 
which are signalized by the formation of exostoses of different 
parts on one or more of the legs. Hereditary predispositions 
make for the presence of spavin in a large percentage of the 
progeny of sires so affected. This fact has been repeatedly 
demonstrated in this country as well as elsewhere according to 
Quitman, Dalrymple and Merillat.^ A number of states have 
passed stallion inspection laws stipulating that animals having 
such exostoses as spavin and ringbone cannot be registered ex- 
cept as "unsound." 

Asymmetrical conformation, particularly Avhere the hock is 
obviously small and weak as compared with other parts of the 
leg, constitutes a noteworthy predisposing cause. 

Peters' theory is plausible that the screw-like joint between 
the tibia and the tibial tarsal (astragulus) bones causes these 
structures to functionate in a manner not in harmony with the 
provisions allowed by the collateral ligaments of the tarsus, per- 



iDiscussions on paper entitled "The Spavin Group of Lamenesses," by W. L. 
Williams, Carl W. Fisher and D. H. Udall, Proceedings of American Veteri- 
nary Medical Association, 1905. 



LAMENESS IN THE HIND LEG 237 

mitting movement only in a direction parallel with the long axis 
of the body. 

Because of the quality of their temperaments, nervous animals 
possessing no particular congenital structural defects of the 
hock and having no history of spavined progenitors, are subject 
to spavin when kept at work likely to produce tarsal sprain. 
Spavin usually develops early in such subjects and examples of 
this kind may be frequently observed in agricultural sections 
of the country. Where spavin develops in unshod colts at three 
and four years of age, shoeing is not an influencing agency when 
animals are not worked on pavements. 

Exciting causes of spavin are sprain and concussion. Various 
hypotheses are recorded as to how sprains are influenced and 
among others mny he mentioned that of IMcDonough^ which is 
that the foot is robbed of its normal manner of support by the 
ordinary three-calked shoe. With such a shoe, little support is 
given the sides of the foot; hence, undue strain is put upon the 
collateral ligaments of the tarsus. IMoreover, the shoe with its 
calks increases the length of the leg and adds to the leverage 
on the hock, by virtue of such added length. This makes for 
greater strain upon the mesial or lateral tarsal ligaments when- 
ever the foot bears upon a sloping ground surface, so that one 
side (inner or outer) is higher or lower than the other. But 
according to McDonough's theory (a good one concerning horses 
that work on pavements), the chief error in shoeing lies in that 
the foot is deprived of its normal base or support on the sides 
— the three-calked shoe being an unstable support — and that 
this manner of shoeing city horses working on pavements is an 
"inhumane" practice, a "diabolical method." 

Whether spavin has its point of origin within the articulation 
as a rarefying ostitis of the cancellated structure of the loAver 
tarsal bones as suggested by Eberlein ; or, as Diekerhoff asserts, 
that the cunean bursa may be the initial point of affection, is 
unsettled ; but it is reasonable to consider occult spavin as having 
its origin within the articulation, and that cases readily yielding 



i"Hock-Joint Lameness." by Dr. James McDonough, Proceedings of the 
A. V. M. A., 1913, page 545. 



238 LAMENESS OF THE HORSE 

to eunean tenotomy are primarily due to affection of the eunean 
bursa. 

Symptomatology. — Where a visible exostosis exists, the pres- 
ence of spavin is easily detected, yet exostoses that extend over 
large areas may constitute cause for serious trouble and still be 
difficult of detection. By observing the internal surface of the 
hock from various suitable angles, such as from between the 
forelegs or directly behind the subject, one may note the pres- 
ence of any ordinary exostosis. 

The position assumed by the spavined horse is often charac- 
teristic. More or less knuckling is usually present (Liautard, 
McDonald) . There is abduction of the stifle in some cases, or the 
toe may be worn in unshod horses so that it presents a straight 
line at the surface. This is manifested to a great degree in some 
animals and in others the foot is not dragged and there is no 
wearing of the hoof at the toe. 

Spavin lameness is so distinctive that one trained and experi- 
enced in the examination of horses that are spavined, should 
correctly diagnose the condition in practically every instance 
without recourse to other means than noting the peculiar char- 
acter of the gait of the subject. Lameness develops gradually 
in the majority of instances, and an important feature in spavin 
lameness is that it disappears after the subject has gone a little 
M^ay, to return again as soon as the animal has rested for a 
variable length of time — from a half hour to several hours. This 
''warming out" is marked during the incipient stage, but less 
pronounced in most chronic cases. A complete disappearance 
of lameness is observed in some instances, while in others only 
partial subsidence is evident. Because of the fact that pain is 
occasioned both during weight bearing and while the leg is being 
flexed and advanced, there is manifested the characteristic mixed 
lameness and exaggerated hip action which typifies spavin. By 
throwing the hips upward with the sound member it is possible 
to advance the affected leg with less flexion, hence less pain is 
experienced in this manner of locomotion. When made to step 
aside in the stall, a spavined horse will flex the affected member 
abruptly and when weight is taken on the diseased leg, symp- 



LAMENESS IN THE HIND LEG 239 

toms are evinced of pain, and weight is immediately shifted to 
the sound limb. This is marked during the incipient stages of 
spavin. Lameness usually precedes the formation of exostosis, 
though cases are observed wherein an exostosis is present and 
no lameness is manifested and no history of the previous exist- 
ence of lameness is available. 

The "spavin test" is of value as a diagnostic measure when 
it is employed with other means of examination, though reaction 
to this test is seen in some cases in old "crampy" horses that 
have experienced hard service. The test consists in flexing the 
affected leg (elevating the foot from the ground twelve to 
twenty- four inches) and holding the member in this position for 
a minute, whereupon the animal is made to step aAvay immedi- 
ately at a trot. During the first few steps taken directly there- 
after, the subject shows pronounced lameness and this constitutes 
a reaction to the spavin test. 

Where no exostosis is present it becomes necessary to exclude 
other causes for lameness but the characteristic spavin-lameness 
is to be relied upon to a greater extent in such cases than are 
other means of examination. Such cases are known as occult 
spavin and may be present for months before any external 
changes in structure are observable. In some instances no ex- 
toses form even during the course of years. The spavin test is 
of aid in establishing a dfagnosis here but the marked "warm- 
ing out" peculiar to spavin is not so pronounced in such cases. 

Prognosis. — An animal having hereditary predisposition to 
spavin is not likely to recover completely whether this predis- 
position be due to faulty conformation or susceptibility to bone 
changes. In predicting the outcome, the temperament of the 
subject is to be taken into account, as well as the character of 
service the animal is expected to perform. And finally, a very 
important feature to be noted, is the location of the exostosis. 
If situated rather high and extending anterior to the hock, there 
is less likelihood of recovery resulting than where an exostosis 
is confined to the lower row of tarsal bones. When situated 
anterior to the tarsus a large exostosis may by mechanical inter- 
ference to function, cause lameness when all other causes are 



240 LAMENESS OF THE HORSE 

absent. In making examinations one must not be deceived 
by the inconspicuous and seemingly insignificant exostosis which 
has a broad base. In some cases of this kind, dealers style the 
condition as "rough in the hock" when as a matter of fact, in 
some instances, incurable spavin lameness develops. 

Treatment. — Many incipient eases of spavin yield to vesica- 
tion and a protracted period of rest. Results depend primarily, 
upon the nature of the affection. However, in every instance 
if there is involvement of the tibial tarsal (astragalus) bone, 
complete recovery is highly improbable. When the disease is 
confined to the lower tarsal bones, lameness subsides as soon as 
the degenerative changes are checked and ankylosis occurs. 

The use of the actual cautery when properly employed con- 
stitutes an excellent method of treatment. The "auto-cautery" 
when equipped with a point of about one-eighth of an inch in 
diameter and about three-fourths of an inch in length is well 
suited for this particular operation. Before deciding to cauter- 
ize, it is necessary to ascertain the extent of area affected. The 
nearness of the exostosis to the tibiotarsal articulation can be 
definitely determined by palpation. The hair over the entire 
surgical field is clipped and the cautery at white heat is pushed 
through the overlying soft tissues and into the central part of 
the exostosis. Care is taken to keep the cautery-point away from 
the articular margin of the tibial tarsal bone about three-fourths 
of an inch. No danger will result from cauterizing to a depth 
of three-fourths of an inch in the average case. Two or three 
(and not more) centrally located points for penetration with the 
cautery are sufficient. Experience has shown that several (five 
or six or more) punctures are not productive of good results. 
When considerable cicatricial tissue is present, due to the action 
of depilating vesicants or other chemicals, sloughing of tissue 
is very apt to follow deep cauterization, if one is not careful to 
keep the punctures at least one-half inch apart when three are 
made. It is best, in such cases, to make but two deep penetra- 
tions with the cautery but additional superficial punctures may 
be made if kept about three-fourths of an inch distant and not 
nearer than this to one another. Sloughing of tissue is not nec- 
essarily productive of bad results but there is occasioned an open 



iLAMENESS IN THE HIND LEG 241 

wound wliieli usually becomes infected and necrosis of tissue may 
extend into the articulation. No benefit results from sloughing 
and it should be avoided. In small horses, one deep point of 
cauterization is sufficient if the osseous tissues are penetrated to 
a proper depth so that an active inflammation is induced. The 
cautery may, if necessary, be reintroduced several times. When 
the field of operation has been properly prepared and it is 
thought advisable (as where subjects are kept in the hospital for 
a time), the hock may be covered with cotton and bandaged and 
no chance for infection will occur. 

After cauterization the subject should be kept quiet in a com- 
fortable stall for three weeks; thereafter, if the animal is not 
too playful, the run of a paddock may be allowed for about ten 
days and a protracted rest of a month or more at pasture is 
best. It is unwise in the average case to put an animal in 
service earlier than two months after having been "fired." 

Where cases progress favorably, lameness subsides in about 
three weeks after cauterization and little if any recurrence of 
the impediment is manifested thereafter. However, because of 
violent exercise taken in some instances when subjects are put 
out after being confined in the stall, a return of lameness occurs 
and it may remain for several days or in some cases become per- 
manent. No good comes from the use of blistering ointments 
immediately after cauterization. The actual cautery is a means 
of producing all necessary inflammation and it should be so em- 
ployed that sufficient reactionary inflammation succeeds such 
firing. The use of a vesicating ointment subsequent to cauteriza- 
tion invites infection because of the dust that is retained in con- 
tact with the wound. The employment of irritating chemicals 
in a liquid form following firing is needless and cruel. 

In many instances lameness is not relieved and subjects show 
no improvement at the end of six weeks time and it theu becomes 
a question of whether or not recovery is to be expected even with 
continued rest and treatment. As a rule, such cases are unfavor- 
able. In one instance the author employed the actual cautery 
three times during the course of six montlis and lameness gradu- 
ally diminished for a year. In this case the spavin was of nearly 
one year's standing when treatment was instituted. The sub- 



242 LAMENESS OF THE HORSE 

ject was a nervous and restless but well-formed seven-year-old 
gelding. Recovery was not complete; recurrent intervals of 
lameness marked this case, but the horse limped so slightly that 
the average observer could not detect its existence after the ani- 
mal had been driven a little way. 

Cunean tenotomy has been advocated and practiced by Abild- 
gaard, Lafosse, Peters, Herring, Zuill and others and good re- 
sults have followed in many cases so treated. 

Considering results, the employment of chemicals of various 
kinds for the purpose of relieving spavin lameness does not com- 
pare favorably with firing. Moreover, so many animals have 
been tortured and needlessly blemished in the attempted cure 
of spavin that agents which are not of known value, the use of 
which are likely to result in extensive injury to the tissues, are 
only to be condemned. 

When spavin is bilateral and lameness is likewise affecting 
both members, prognosis is at once unfavorable. Such cases are 
often benefited by cauterization but only one leg at a time should 
be treated. 

Bossi's double tarsal neurectomy (division of the anterior and 
posterior tibial nerves) has undoubtedly been of decided benefit 
in many cases, but is not at present a popular method of treat- 
ment in this country. This operation has its indications, how- 
ever, and may be recommended in chronic lameness where no 
extensive exostosis exists which may mechanically interfere with 
function. 

Distension of the Tarsal Joint Capsule. (Bog Spavin.) 

Distension of the capsular ligament of the tibial tarsal (tibio- 
astragular) joint with synovia is commonly known as bog spavin. 
This condition is separate and distinct fiom that of distension 
of the sheath of the deep flexor tendon (perforans) though not 
infrequently the two affections coexist. 

Etiology and Occurrence. — Following strains from w^ork in 
the harness or under the saddle, horses develop an acute syno- 
vitis of the hock joint, which often results in chronic synovial 
distension. Debilitating diseases favor the production of this 



LAMENESS IN THE HIND LEG 



243 



affection in some animals. It is also frequently observed in 
young horses and in draught colts of twelve to eighteen months 
of age. This condition occurs while the subjects are at pasture 





r 



/ 



I 






l« 



Fig. 56 — Bog spavin. Showing point of view which may be most advan- 
tageously taken by the diagnostician in examining for distension of the 
capsular ligament of the tarsal joint. 

and often spontaneous recovery results by the time the animals 
are two years of age. 

Symptomatology. — Bog spavin is recognized by the dis- 
tended condition of the joint capsule which is prominent just 
below the internal tibial malleolus and this affection is character- 



244 LAMENESS OF THE HORSE 

ized by a fluctuating swelling which varies considerably in size 
in different subjects. Except in cases of acute synovitis, lame- 
ness is not present and in chronic distension of the capsule of 
the tarsal joint, no interference with the subject's usefulness 
occurs. In the majority of instances, the disfigurement which 
attends bog spavin is the principal objectionable feature. The 
condition is bilateral in many instances, and in such cases the 
subjects have a predisposition to this condition or it follows 
attacks of strangles or other debilitating ailments. Because of 
a rapid and unusual growth, bilateral affections are of frequent 
occurrence in some animals. 

Treatment. — The most practical method of handling bog 
spavin consists in aspiration of synovia and injection of tincture 
of iodin. Discretion should be employed in selecting subjects 
for treatment, regardless of the manner in ^^■hicll such cases are 
to be handled. Where there exists chronic distension of the 
joint capsule of several years' standing in old or weak subjects, 
needless to say, recovery is not likely to result. When animals 
are vigorous and two or three months' time is available, treat- 
ment may be begun with reasonable hope for success. 

The average subject is handled standing and can be restrained 
with a twitch, sideline and hood. Aspirating needles and all 
necessary equipment must be in readiness (sterile and wrapped 
in aseptic cotton or gauze) so that no delay will occur from this 
cause when the operation has been started. The central or most 
prominent part of the distended portion of the capsule is chosen 
for perforation and an area of an inch and a half in diameter 
is shaved. The skin is cleansed and then painted with tincture 
of iodin. The sterile aspirating needle is pushed through the 
tissues and into the capsule with a sudden thrust. With a large 
and sharp needle (fourteen gauge), synovia can be drawn from 
the cavity in most instances and the subject usually offers no 
resistance. By compressing the distended capsule and surround- 
ing structures with the fingers, considerable synovia may be 
evacuated. In singular instances, no synovia is to be aspirated 
with the needle, and in such cases the amount of iodin injected 
needs be increased, possibly twenty-five per cent., as experience 



LAMENESS IN THE HIND LEG 245 

will indicate. From two to five cubic centimeters of U. S. P. 
tincture of iodin is injected through the aspirating needle into 
the synovial cavity of the joint, and the exterior of the parts are 
vigorously massaged immediately after injection to stimulate 
distribution of the iodin throughout the synovial cavity. Where 
a bilateral affection exists, two or three weeks' time should inter- 
vene between the treatments of each leg. A sterile metal syringe 
equipped with a slip joint for the needle is well adapted to this 
operation. Lubrication of the plunger with heavy sterile vaseline 
or glycerin will prevent the syringe from being ruined by the 
iodin. 

Following the injection, the subject is kept in a stall or in 
a suitable paddock, so that conditions may be observed for four 
or five days. The object sought by the introduction of iodin 
is not only for a local effect upon the synovial membranes in 
checking secretions, but the production of an active inflamma- 
tion and great swelling, which will remain from four weeks 
to three months subsequent to the injection. This periarticular 
swelling should produce and maintain a constant pressure over 
the entire affected parts for a sufficient length of time until nor- 
mal tone is re-established. 

In some cases, swelling does not develop as the result of a 
single injection of iodin. When marked swelling has not taken 
place within five days, none will occur and a repetition of the 
injection may be made within ten days after the first treatment 
has been given. One may safely increase the amount of iodin 
at the second injection in such cases by one-fourth to one-third. 

In Europe this method of treating bog spavin has been em- 
ployed by Leblanc, Abadie, Dupont and others according to 
Cadiot; but Bouley, Rey, Lafosse and Varrier used it with bad 
results. Where a perfect technic is executed (and no other is 
excusable in this operation), no infection will occur if a reason- 
al)le amount of iodin is injected. The dilution of iodin with an 
equal amount of alcohol has been practised by the author in 
many cases, but later this was found unnecessary. 

Other methods of treatment have been used with success. Per- 
haps the most heroic consists in opening the joint capsule with a 



246 LAMENESS OF THE HORSE 

bistoury or with the actual cautery. Such practice is too hazard- 
ous for general use and is not to be recommended, although good 
results should follow the employment of such methods if infec- 
tious arthritis does not occur. 

Line firing over the distended capsule is a practical method 
of treatment. This is attended with good results in young ani- 
mals in many cases, but considerable blemish is caused when 
sufficient irritation is produced to stimulate resolution. 

Vesication also is successfully employed in some instances. 
However, only cases of recent origin in young animals — colts of 
two years or younger — yield to blistering, and in some affected 
colts no doubt recovery would have been spontaneous had no 
treatment been instituted. 

Ligation of the saphenous vein at two points, one above and 
the other below the distended ligamentous capsule, is an old 
operation, which has undoubtedly given good results in some 
cases, although it does not seem to be a rational procedure. 

After-Care. — After swelling has fully developed — which oc- 
curs within a week — the subject is turned to pasture and no at- 
tention is necessary thereafter. A gradual subsidence of the 
swelling occurs and in the average instance, this completely re- 
solves within six or eight weeks. 

Complete recovery succeeds the aspiration-and-injection-treat- 
ment in about seventy-five per cent of cases as the result of one 
operation, and subjects may be gradually and carefully returned 
to work in about sixty days after treatment has been given. 

Distension of the TarsaJ Sheath of the Deep Digital Flexor. 
(Thoroughpin. ) 

The terms "thoroughpin" or ' ' throughpin " are translations 
from the French vessignon cheville and have the same signifi- 
cance. They are so named because of the diametrically opposed 
distensions of the sheath of the deep flexor tendon in such man- 
ner that the distensions appear to be due to a supporting peg. 

Anatomy. — The theca through which the deep digital flexor 
(perforans) plays in the tarsal region, begins about three inches 



LAMENESS IN THE HIND LEG 247 

above the inner tibial malleolus and extends about one-fourth 
of the way down the metatarsus. The posterior part of the 
capsular ligament of the hock joint is very thick in its most 
dependent portions and is in part cartilaginous, forming a suit- 
able groove for the passage of the deep flexor tendon. 

Etiology and Occurrence. — Strains and sequellae to debili- 
tating diseases constitute the usual causes of this affection. As 




Fig. 57 — Thoroughpin. Showing distension of the sheath of the deep flexor 
tendon as it protrudes antero-externally to the fibular tarsal bone (cal- 
caneum). 

a result of acute synovitis a chronic synovial distension of the 
tarsal sheath occurs. Bog spavin is often present in case of 
thoroughpin but the two conditions are separate and distinct 
excepting in that both may occur simultaneously and as the 
result of the same cause. Some animals are undoubtedly pre- 
disposed to disease of synovial structures. The average horse 
that has been subjected to hard service on pavements or hard 
roads at fast work suffers synovial distension of bursae, thecae 
or of joint cap.sules. Some of the well bred types such as the 



248 



LAMENESS OF THE HORSE 



thoroughbred horses may be subjected to years of hard service 
and still remain "clean limbed" and free from all blemishes. 
Thus it seems that subjects of rather faulty conformation, ani- 
mals having lymphatic temperaments and the coarse-bred types, 
are prone to synovial disturbances such as thoroughpin, bog 
spavin, etc., sometimes having both legs affected. 

Symptomatology. — Thoroughpin is characterized by a dis- 
tended condition of the tarsal sheath which is manifested by 




Fig. 5S — Fibrosity of tarsus as a complication in chronic thoroughpin. 

protrusions anterior to the tendo Achillis. However, where but 
moderate distension of the sheath exists, there is little, if any, 
bulging on the mesial side of the hock and but a small hem- 
ispherical enlargement is presented on the outer side of the 
tarsus, anterior to the summit of the os calcis. In some instances 
the protruding parts assume large proportions, but always, be- 
cause of the relationship between the fibular tarsal bone (cal- 
caneum) and the tendon sheath, the larger protrusion is situated 
mesially. 



LAMENESS IN THE HIND LEG 



249 



During the acute inflammatory stage there is marked lameness 
present but tliis soon subsides when local antiphlogistic agents 
are applied to the parts. In fact, spontaneous relief from lame- 
ness usually results in the course of ten days' time following the 
appearance of thoroughpin. No lameness marks the advent of 




Fig. 59 — Another view of same case as illustrated in Fig. 5S. 

this affection when it develops as the result of continuous sti-ain 
and concussion occasioned by hard service, and local changes 
tend to remain in status quo. 

Treatment. — Rest and the local application of heat or cold 
will suffice to promote resolution of acute inflammation and lame- 
ness when present will subside within two weeks. In chronic 
affections, however, the matter and manner of effecting a cor- 



250 LAMENESS OF THE HORSE 

rection of the condition — distended tarsal sheath — merit careful 
consideration. "While drainage of distended thecae and bursas 
by means of openings made with hot irons was practiced by the 
Arabs, centuries ago, and good results have attended such heroic 
corrective measures, nevertheless the occasional serious comi^lica- 
tions M'hich result from infection likely to be introduced in fol- 
lowing such procedures, cause the prudent and skilful practi- 
tioner to employ safer methods of treatment. 

The application of blistering agents is of no value in stimu- 
lating resorption of an excessive amount of synovia in chronic 
cases and the actual cautery when employed without perfora- 
tion of the synovial structure, is of little benefit. Trusses or 
mechanical appliances for the purpose of maintaining pressure 
upon the distended parts are of no practical value because 
of the great difficulty of keeping such contrivances in position. 
They usually cause so much discomfort to the subject that they 
are not tolerated. 

A very practical and fairly successful method of treatment 
consists in the aspiration of a quantity of synovia and injecting 
tincture of iodin. Cadiot recommends the drainage of synovia 
Avith a suitable trocar and cannula and injecting a mixture 
consisting of tincture of iodin, one part, to two parts of sterile 
water, to which is added a small quantity of potassium iodid. 
The latter agent is added to prevent precipitation of the iodin. 
This authority (Cadiot) further advocates the removal of prac- 
tically all of the synovia that will run out through the cannula 
and the immediate introduction of as much as one hundred cubic 
centimeters of the above mentioned iodin solution. This solu- 
tion is allowed to remain in the synovial cavity a few minutes 
and by compressing the tissues surrounding the tendon sheath, 
the evacuation of as much of the contents of the synovial cavity 
as is practicable, is effected. Subsequently the subject is al- 
lowed absolute rest and more or less inflammatory reaction fol- 
lows. In some cases there occur marked lameness and some 
febrile disturbance, but where a good technic is carried out, 
no bad results follow. At the end of four weeks' time, horses 
so treated may be returned to service, but the full beneficial 



(LAMENESS IN THE HIND LEG 251 

effect of such treatment is not experienced until several months' 
time have elapsed. 

Where good facilities for executing a careful technic in every 
detail are at hand, incision of the tarsal sheath, evacuation of 
its contents and uniting its walls again by means of sutures 
and providing for drainage with a suitable drainage tube, may 
be practiced. This manner of treatment has been satisfactory 
in the hands of a number of surgeons. 

Capped Hock. 

Enlargements which occur upon the summit of the os ealcis, 
whether hypertrophy of the skin and rmbcuticular fascia, the 
result of injury or repeated vesication, distension of the sub- 
cutaneous bursa or injury to the superficial flexor tendon (per- 
foratus) or its sheath, are generally knoM'^n as capped hock. 
However, the term should be restricted to use in reference to 
distensions of synovial structures of that region. 

Etiology and Occurrence. — Usually there occurs a hygrom- 
atous involvement of the subcutaneous bursa due to contusion. 
As in bog spavin, following certain infectious diseases (influ- 
enza, purpura hemorrhagica, etc.) there remains a distended con- 
dition of the subcutaneous bursa, after swelling of the member 
has subsided. In feeding pens where numbers of young mules 
are kept in crowded quarters many cases may be observed. In 
some instances where violent contusions result from kicking 
cross-bars of wagon shafts (by nymphomaniacs or in habitual 
kickers where there is opportunity for doing such injury) the 
superficial flexor tendon and its synovial apparatus are injured 
and a more serious condition may result. 

Symptomatology. — In acute and extensive inflammation of 
the pai'ts, lameness is present, but in the average case no in- 
convenience to the subject results. The prominent site of the 
affection is cause for an unsightly blemish. This is undesirable, 
particularly in light-harness or saddle horses. These affections 
are characterized by a fluctuating mass which has a thin wall 
and in all cases of long standing the condition is painless. 



252 LAMENESS OF THE HORSE 

By careful palpation one may readily distinguish between a 
hygromatous condition of the superficial bursa and involvement 
of the underlying structures. Affection of the expanded portion 
of the flexor tendon and contiguous structures makes for an 
organized mass of tissue which is somewhat dense and in some 
instances painful to the subject when manipulated. This is par- 




Fig. 60 — "Capped hock." Distension of the bur.sa o-\er the summit of the 
OS calcis. 

ticularly noticeable in cases where the parts are regularly and 
repeatedly injured as in habitual kickers. 

Treatment. — In acute inflammation, antiphlogistic applica- 
tions are indicated and the subject must be kept quiet. The 
matter of bandaging the hock is a difficult problem in some cases 
and needs be done with care. As has been previously stated in 
this volume, the tarsus needs to be well padded with cotton be- 
fore the bandages are applied and only a moderate degree of 
tension is employed in applying the bandages lest anemic-necrosis 
result from pressure. In distension of the superficial bursa, 
after clipping the hair over a liberal area and preparing the skin 



LAMENESS IN THE HIND LEG 253 

by thoroughly cleansing and painting with tincture of iodin, the 
capsule is incised with a bistoury. An incision ahout an inch 
in length, situated low enough to provide drainage, is made 
through the tissues and the contents are evacuated. Tincture 
of iodin is injected into the cavity and the parts are covered 
with cotton and bandaged. No after-care is necessary except to 
retain the dressing in position, which is not difficult in the 
average case if the subject is kept tied. If much resistance is 
exhibited, such as extreme flexion of the bandaged hock, the 
animal may be put in a sling and little if any objection to the 
bandage will be offered thereafter. The wound may be dressed 
at the end of forty-eight hours and no redressing will be neces- 
sary in the average instance if infection is not present. But 
slight local disturbance and little distress to the subject result 
in cases so treated even when infection occurs, but a good technic 
is possible of execution in most instances and no infection should 
take place. 

The surgical wound heals in two or three weeks and inflamma- 
tion gradually sul)sides. Bandages are retained one or two 
weeks, as the case may require, and subsequently a good wound 
lotion may be employed several times daily. A good lotion for 
such cases as well as in many others has long been employed 
with success by Dr. A. Trickett of Kansas City. It consists of 
approximately equal parts of glycerin, alcohol and distilled ex- 
tract of witch hazel, to which is added liquor cresolis compositus, 
two percent, and coloring matter q. s. 

Complete resolution does not occur in the average case. There 
remains some hyperplastic tissue and even where the enlarge- 
ment is slight, the prominent situation of the affection precludes 
its being unnoticed. 

In disease of the flexor tendon and its bursa where contiguous 
inflammation of tissue is present, the parts are blistered or fired. 
Line firing is beneficial in such instances but in all cases the 
cause is to be removed if possible. 

Rupture and Division of the Long Digital Elxtensor 
(Extensor Pedis). 

Etiology and Occurrence. — Because of the fact that the long 



254 LAMENESS OF THE HORSE 

digital extensor is the only extensor of the phalanges of the 
pelvic limb, its rupture or division constitutes a troublesome 
condition, which in some cases does not readily respond to treat- 
jnent. 

Rupture of this tendon may occur during work on rough and 
uneven roads, particularly in range horses that are ridden over 
ground that is burrowed by gophers or prairie dogs; in such 
cases, horses are apt to suddenly and violently turn the foot 
in position of volar flexion, thereby causing undue strain to the 
digital extensor and its rupture sometimes follows. In foals 
of- one or two days of age, this tendon is sometimes found parted 
or ruptured and the condition may be bilateral. 

As the result of accidents, the digital extensor may be divided 
and when the wound becomes contaminated, as it does because 
of the marked volar flexion (knuckling) which occurs during the 
course of this affection, regeneration of tissue is checked and re- 
covery is tardy. 

Symptomatolog'y. — There is no interference with ability to 
sustain weight in such cases, when the foot is placed in normal 
position; but immediately upon attempting to walk, the toe is 
dragged, and if weight is borne with the affected member, it 
comes upon the anterior face of the fetlock. The flexors are 
not antagonized and if there be an open wound the parts soon 
become contaminated; or, in rupture, if animals travel about 
very much, there soon occurs necrosis of the tissues of the 
anterior fetlock region and the condition is rendered in- 
curable. Cases are reported of animals that have suffered rup- 
ture of the long digital extensor and the subjects learned to 
throw the member forward during extension, substituting for 
the extensor tendon the pendulum-like momentum which the foot 
affords when so employed; and a walking and even a trotting 
pace was possible without doing injury to the fetlock region. 

Where a subcutaneous division exists as in rupture, the di- 
vided ends of the tendon may be definitely recognized by palpa- 
tion. 

Treatment. — Subjects are best put in slings and kept so con- 
fined until regeneration of tendinous structures has been com- 



LAMENESS IN THE HIND LEG 255 

pleted. This reciuires from six weeks to two month.s' time. In 
addition, the extremity is kept in a state of extension l)y means 
of suitable splints and shoes, — a shoe equipjx'd with an exten- 
sion at the toe and perforated so that a steel brace may be hooked 
into the perforation and the brace fashioned to be buckled to 
the upper metatarsal region. When braces are placed in front 
of the foot, great care is necessary in properly padding the mem- 
ber with cotton lest sloughing from pressure occurs at the coro- 
net ; but this does not apply in rupture of extensors so much 
as where flexors are ruptured. 

Open wounds are treated along general surgical lines, dressed 
as frequently as occasion demands, and recovery will be complete 
in a few months' time unless much of the tendon has been de- 
stroyed. In one in.stance, the author had occasion to observe 
such a condition, which, because of the extensive destruction 
of tendon and lack of facilities for giving proper attention to 
the subject, results were so unfavorable that it was deemed 
necessary to destroy the animal. 

Wounds From Interfering. 

When, during locomotion, injury is inflicted upon the mesial 
side of an extremity by the swinging foot of the other member, 
the condition is termed interfering. 

Etiology and Occurrence. — Faulty conformation, bad shoe- 
ing and over-work are the principal causes of interfering. 
Horses that are "base narrow" or that have crooked legs are 
quite apt to interfere. Shoes that are put on a foot tliat is not 
level or applied in a twisted position, or shoes wide at the heel 
will often cause interfering and injury. Animals that are driven 
at fast work until they become nearly exhausted may be expected 
to interfere. Such cases are frequently observed in >oung horses 
that are driven over rough roads, particularly when so nearly 
exhausted or weakened from disease or inanition that the feet 
are dragged forward rather than picked uj) and advanced in 
the normal nuinner. 

Symptomatology. — Wounds inflicted by striking the extrem- 
ities in this nuinner present various appearances and occasion dis- 



256 LAMENESS OF THE HORSE 

.similar manifestaticns. The hind legs are almost as frequently 
affected as the front and the fetlock region is most often injured, 
though wounds may be inflicted to the coronet. In front, the 
carpus is sometimes the site of injury. 

When only an abrasion is caused, little if any lameness oc- 
curs, but where interfering is continued and nerves are involved 
or subfascial infection and extensive inflammation succeed such 
abrasions, marked lameness and evidence of great pain are mani- 
fested. Frequently, in chronic cases affecting the hind leg, the 
fetlock assumes large proportions, and at times during the course 
of every drive the subject strikes the inflamed part, immediately 
flexing and abducting the injured member, and the victim hops 
on the other leg until pain has somewhat subsided. 

Interfering is much more serious in animals that are used at 
fast Avork than in draft horses. In light-harness or saddle horses, 
it may render the subject practically valueless or unserviceable 
if the condition cannot be corrected. 

Treatment. — Wherever possible, cause is to be removed and 
if animals are properly used, ordinary interfering wounds will 
yield to treatment. If the shoeing is faulty, this should be cor- 
rected, the foot properly prepared and leveled before being shod 
and suitable shoes applied. In young animals that become "leg- 
weary" from constant overwork, rest and recuperation are neces- 
sary to enhance recovery. In such cases it will be found that 
very light shoes, frequently reset, will tend to prevent injury to 
the fetlock region such as characterizes these injuries of hind 
legs. 

Palliative measures of various kinds are employed where 
cause is not to be rem,oved and a degree of success attends 
such effort. In draft horses or animals that are used at a slow 
pace, shields of various kinds are strapped to the extremity 
and protection is thus afforded. Or, large encircling pads of 
leather, variously constructed, serve to cause the subject to 
walk watli the extremities apart. 

Interfering shoes of different types are of material benefit in 
many instances. Often the principle upon which corrective shoe- 
ing is based is that the mesial (inner) side of the foot is too 
low ; the foot is consequently leveled and the inner branch of the 



LAMENESS IN THE HIND LEG 257 

shoe is made thicker than the outer, altering the i)Osition of the 
foot in this way. This is productive of desirable results. How- 
ever, much depends upon the manner in which the foot in motion 
strikes the weight-bearing member as to the cori-ective measures 
that are indicated. This belongs to the domain of pathological 
shoeing and the reader is referred to works on this subject for 
further study of this phase of lameness. 

Lymphangitis. 

Excluding glanders, in the majority of instances, lymphangitis 
in the horse, such as frequently affects the hind legs, is due to 
the local introduction of infectious material into the tissues as 
a result of wounds. However, one may observe in some instances 
an acute lymphangitis which affects the pelvic limbs of horses 
and no evidence of infection exists. Conseciuently, lymphangitis 
may be considered as infectious and non-infections. 

INFECTIOUS LYMPHANGITIS. 

Etiology and Occurrence. — Traumatisms of the legs fre- 
quently result in infection and when such injuries are near 
lymph glands, even though the degree of infection be slight, 
more or less disturbance of function of the muscles in the vicinity 
of such glands occurs and lameness follows. 

The prescapular, axillary and cubital lymph glands when in a 
state of inflammation, cause lameness of the front leg, and the 
superficial inguinal and deep inguinal lymph glands not infi'e- 
quently become involved also. Because of the location of these 
lymph glands, they are subject to comparatively frequent injury 
and inflammation, causing lameness more often than other lymph- 
gland-att'ections. 

Small puncture wounds in the region of the elbow are often 
met with. These may be inflicted when horses lie down upon 
sharp stumps of vegetation or shoe-calk injuries may be the 
means of introducing eontagium, and an infectious inflammation 
results. Al)scess formation, the result of strangles or other in- 
fection in the prescapular glands, may be observed at times. 
Following castration, the inguinal lymph glands may become 
involved in an infectious inflannnation and locomotion is im- 



258 LAMENESS OF THE HORSE 

peded to a marked degree. Horses running at pasture sometimes 
become injured by trampling upon pieces of wood, causing one 
end of these or of various implements to become embedded in the 
soft earth and the other end to enter at the inguinal region and 
even penetrate the tissues to and through the skin and fascia just 
below the perineal region. 

Nail punctures resulting in infection frequently cause an in- 




Fig. 61 — Chronic lymphangitis. Showing hypertrophy of the left hind leg, 
due to repeated inflammation. 

fectious lymphangitis and a marked and painful swelling of the 
legs supervenes. 

Symptomatology. — Lameness, mixed or swinging-leg, signal- 
izes the presence of acute lymphangitis. There is always more 
or less swelling present and manipulation of the affected parts 
gives pain to the subject. Depending upon the character of the 
infection and its extent, there is presented a varying degree of 
constitutional disturbance. There may be a rise in temperature 
of from two to five degrees, and in such instances there is an 
accelerated pulse. Where much intoxication is present, anorexia 
and dipsosis are to be noticed. 



LAMENESS IN THE HIND LEG 



259 



Swelling may increase gradually and in time discharge of pus 
may take place spontaneously without drainage being provided 
for, if the character of the infection does not cause early death. 




Fig. 62 — Elephantiasis. 

In these cases lameness is pronounced and the cause of the dis- 
turbance is to be sought, particularly if the condition be due to 
a nail puncture. 

Treatment. — Location of tlie site of injury is advisable in 



260 LAMENESS OF THE HORSE 

all eases and in some instances provision for drainage, as in 
puncture wounds, is helpful. Locally, curettage and the appli- 
cation of suitable antiseptics are indicated. Hot fomentations 
are beneficial and should be continued for several days if neces- 
sary, to stimulate resolution. A brisk purge should be admin- 
tered at the onset and strychnin, because of its indirect stimu- 
lative effect upon the circulation together with its tonic effect 
upon the musculature, is beneficial. 

In all such cases rational treatment, good hygiene and careful 
nursing are the principal factors which stimulate recovery. In- 
dividual resistance or lowered vitality has a marked influence 
on the course of this affection. 

NON-INFECTIOUS LYMPHANGITIS. 

This type of lymphangitis is associated with, or the result of, 
a derangement of digestion. It affects heavy draft horses, rarely 
other types of animals, and involves one or both hind legs. 

Occurrence. — In healthy and well nourished horses irregu- 
larly used, this affection may suddenly manifest itself. It oc- 
curs in singular instances in mares that are in advanced preg- 
nancy even when such animals are at pasture. Usually, however, 
this malady is found in heavy draft horses that have been kept 
stabled from one to three days. 

Symptomatolog'y. — At the outset in severe cases, there is 
elevation of temperature, labored breathing, accelerated pulse, 
anorexia and more or less swelling of the affected members. 
Swelling is very painful and when the affected legs are palpated, 
pain is manifested by flinching. The inguinal lymph glands 
are often swollen but in some cases they are not affected in any 
perceptible degree. In the average case suppuration does not 
occur and when conditions are favorable, resolution is complete 
within ten days. The extent of the involvement and the intensity 
of the affection vary materially in different cases and a chronic 
lymphangitis may succeed the acute attacks and finally in 
some instances, elephantiasis results. 

Treatment. — An active purgative should be given at once 
and in the ordinary case, stimulants are indicated. If marked 
distress is present, morphin is given and where there is much 



LAMENESS IX THE HIND LEG 2G1 

rise of temperature, cold drinking water is offered in abundant^ 
and catharsis is enhanced l)y eneniata. Locally, hot appli- 
cations are of benefit. Hot towels or cotton licld in i)osition 
by bandages and kept soaked with warm water will relieve pain 
and stimulate resolution. Diuretics may be of benefit and ano- 
dyne applications are to be employed with profit in some cases. 
Walking exercise, if not indulged in to excess, is helpful as soon 
as acute inflammation has subsided. By giving careful attention 
to the regimen and providing regular exercise for susceptible 
subjects, this type of lymphangitis is often forestalled. 



INDEX 



A 

^.cetabulum 185 

Acute arthritis 65 

Acute laminitis 162 

Acute tendinitis 135 

Affetlons of blood vessels 31 

Affections of bursae and thecae 27 

Affections of the feet 31 

Affections of ligaments 20 

Affections of lymph vessels and 

glands 32 

AffpctioTTs of muscles and ten- 
dons 28 

Affections of nerves 30 

Anamnesis 38 

Anatomo-physiological review 

of parts of fore leg 55 

Anatomo-physiological consid- 
eration of the pelvic limbs. .185 
Anatomy of the joint capsule. .220 

Annular ligament 58 

Antea-spinatus muscle 65 

Anterior brachial re';'ion, 

wounds of 90 

Anterior digital extensor 

muscle 193 

Arteritis 209 

Artery (brachial), thrombosis 

of the 81 

Arthritis 22, 84 

Arthritis, acute 65 

Arthritis, chronic 65 

Arthritis, infectious 66 

Arthritis, metastatic 25 

Arthritis of the fetlock .ioint....l52 

Arthritis, rheumatic 26 

Arthritis, scapulohumeral 65 

Arthritis, tarsal 225 

Arthritis, traumatic 22 



Articular ringbone 121 

Articulation, femeropelvic 185 

Articulation, m e t a carpophal- 

angeal 58 

Articulation, scapulohumeral .. 55 
Aspiration-and-injection treat- 
ment of bog spavin 244 

Aspiration-and-injection treat- 
ment of capped hock 252 

Aspiration-and-injection treat- 
ment of thoroughpin 250 

Astragalus 190 

Astragalus, fracture of the 230 

Attitude of the subject 41 

Atrophy of the quadriceps 

muscles 205 

Atrophy, shoulder 73 

B 

Biceps brachii 58. 65, 68, 69 

Bicipital bursa, inflammation 

of 68 

Blood vessels, affections of 31 

Bog spavin 242 

Bog spavin, aspiration-and-in- 
jection treatment of 244 

Bog spavin, line firing for 246 

Bog spavin, vesication for 246 

Bone spavin 235 

Bones, degenerative changes in 16 

Bones, tarsal 190 

Bossi's double tarsal neurec- 
tomy 242 

Brachial artery, thrombosis of 

the 81 

Brachial paralvsis T7 

Bursa intertubercularis 62. 69 

Bursa podotrochlearis, inflam- 
mation of the 157 

Bursae. affections of 27 



LAMENESS OF THE HORSE 



Bursitis 27, lui 

Bursitis, infectious 28 

Bursitis in tlie fetlock region... .150 

Bursitis intertubercularis 6S 

Bursitis, noninfectious 28 

C 

Calcaneo-cuboid ligaments 190 

Calcaneo-metatarsal ligaments. .190 

Calcaneum, fracture of the 230 

Calk wounds .- 170 

Capped hock 251 

Capped hock, aspiration-and-in- 

jection treatment of 252 

Capsular ligament 190 

Caput muscles 71 

Carpal bones, fructure of the.. 96 
Carpal bones, luxation of the.... 96 
Carpal flexors, contraction of 

the 93 

Carpal flexors, inflammation of 

the - 93 

Carpal .ioint 58 

Carpal joint, open 100 

Carpitis 98 

Carpus, inflammation of the.... 98 
Cartilage, lateral, inflamma- 
tion of 174 

Cartilages of the third phalanx, 

ossification of the 155 

Chronic arthritis 65 

Chronic gonitis 217 

Chronic laminitis 164 

Chronic tendinitis 137 

Cochran shoe for dropped 

soles 169 

Collateral ligaments 190 

Comminuted fractures -.. 17 

Compound fractures 17 

Contracted tendons of foals....! 43 
Contraction of the carpal flexors 93 
Contraction of the flexor ten- 
dons - 1 37 

Contusions of the triceps 
brachii 71 



Contusive wounds 85 

Coracoradialis 58 

Corns 172 

Coronary region, wounds of 

the 170 

Corpora oryzoidea 218 

Cotyloid ligament 185 

Courbe 233 

Crepitation, false 48 

Crepitation, true 47 

Crucial ligaments 188 

Crural nerve, paralysis of the..204 

Cunean bursa 237 

Cunean tenotomy 242 

Cuneiform magnum 191 

Cuneiform medium 191 

Curb 233 

D 

Deep digital flexor, distension 

of the tarsal sheath of 246 

Deep flexor tendon (perforans) 60 
Degenerative changes in bones 16 

Diagnosis by exclusion 53 

Diagnosis by use of the X- 

ray 179 

Diagnostic principles 37 

Disease, navicular 157 

Dislocations 21 

Distension of the tarsal joint 

capsule 242 

Distension of the tarsal sheath 

of the deep digital flexor 246 

Division of long digital ex- 
tensor 253 

Dorsal ligaments 190 

Dropped elbow 71, 80 

Dropped soles, shoe for 169 

Dropped stifle .- 205 

Dry spavin 225 

E 

Elbow, dropped 71, 80 

Elbow, inflammation of tlie 84 



INDEX 



Elbow joint 58 

Elephantiasis 34 

Etiology, general discussion of 15 

Examination by palpation 43 

Examination, special methods 

of 53 

Examination, visual 39 

Exclusion, diagnosis by 53 

Exostosis of splint bones 107 

Exostosis, phalangeal 118 

Extensor (long digital) rupture 

and division of 253 

Extensor of the digit, rupture 

of 145 

Extensor pedis 60 

Extensor pedis, rupture of 145 

Extensor pedis, rupture and di- 
vision of 253 

F 

False crepitation 48 

Feet, affection of the 34 

Femoral nerve, paralysis of 

the 204 

Femeropatella ligaments 188 

Femeropelvic articulation 185 

Femur 185, 192 

Femur, fracture of the 199 

Femur, luxation of the 201 

Fetlock joint 58 

Fetlock joint, arthritis of the.. ..152 
Fetlock joint, luxation of the.. 125 

Fetlock joint, open 110 

Fetlock region, thecitis and 

bursitis in 148 

Fetlock, shoe for bracing the....l81 
Fibular tarsal bone, fracture of 

the 230 

Firing, treatment of ringbone 

by 123 

First phalanx 59 

"Fish knees" 145 

Fixed luxations 21 

Fixed patellar disarticulation. .213 
Flexor brachii 58, 68, 69 



Flexor carpiradialis 93 

Flexor carpiulnaris 93 

Flexor metacarpi externus 94 

Flexor metacarpi internus 93 

Flexor metacarpi medius 93 

Flexor metatarsi 193 

Flexor, superficial digital 194 

Flexor tendons, contraction of 

the 137 

Flexor tendons, inflammation 

of the 135 

Flexor tendons, rupture of 146 

Flexors of phalanges, open 

sheath of 124 

Foals, contracted tendons of....l43 

Forearm, wounds of 90 

Fore leg, lameness in the 55 

Fracture of the carpal bones.... 96 

Fracture of the femur 199 

Fracture of the libular tarsal 

bone 230 

Fracture of first and second 

phalanges 131 

Fracture of humerus 82 

Fracture of the ilium 198 

Fracture of the ischial tuber- 
osity 199 

Fracture of the metacarpus 106 

Fracture of the patella 212 

Fractures of the pelvic bones..l96 
Fracture of the proximal sesa- 
moids 128 

Fracture of the pubis 197 

Fracture of the radius 87 

Fracture of the scapula 62 

Fracture of t"ne tibia 222 

Fracture of the tibial tarsal 

bone 230 

Fracture of the ulna 86 

Fractures 16 

Fractures, comminuted 17 

Fractures, compound 17 

Fractures, green stick 18 

Fractures, impacted 19 

Fractures, longitudinal 18 



LAMENESS OF THE HORSE 



Fractures, multiple .._ 18 

Fractures, multiple longitu- 
dinal 19 

Fractures, oblique 18 

Fractures, simple 17 

Fractures, simple transverse.... 18 

Fractures, transverse 18 

Fragllitas 199 

Fragilitas osseum 128 

G 

Gait, observing character of.... 48 

Gastrocnemius 194 

Gluteal tendo-synovitis 203 

Gluteus medius muscle 192, 203 

Gonitis, chronic 217 

Green stick fractures 18 

H 

Hind leg, lameness in the 185 

Hind leg, paralysis of the 204 

Hip lameness 195 

Hip swinney 205 

Hock, capped 251 

Hock joint 188 

Hoof testers 53 

Humeroradioulnar joint 58 

Humerus, fracture of 82 

I 

Iliac thrombosis 209 

Iliopsoas 204 

Ilium, fracture of the 198 

Impacted fractures 19 

Infectious arthritis 66 

Infectious bursitis 28 

Infectious inflammation of the 

lateral cartilage 173 

Infectious lymphangitis 257 

Infectious synovitis 124 

Inflammation of the bicipital 

bursa 68 

Inflammation of the bursa 

podotrochlearis 157 



Inflammation of the carpal 

flexors 93 

Inflammation of the carpus 98 

Inflammation of the elbow 84 

Inflammation of the flexor ten- 
dons 135 

Inflammation of posterior liga- 
ments of pastern 129 

Inflammation of proximal sesa- 
moid bones 127 

Inflammation of third sesamoid 

and deep flexor tendon 157 

Inflammation of the trochan- 
teric bursa 204 

Infraspinatus muscle 65 

Injection of fluids for quittor....l77 
Injuries to scapulohumeral 

joint 66 

Interfering, shoeing for 256 

Interfering, wounds from 255 

Ischial tuberosity, fracture of 
the 199 



Joint cansulp. anatomy of the..220 

Joint, carpal 58 

Joint, elbow 58 

Joint, fetlock 58 

Joint capsule, tarsal, distension 

of the 242 

Joint, fetlock, arthritis of the....l52 

Joint, fetlock, luxation of 125 

Joint, hock 188 

Joint, humeroradioulnar 58 

Joint, open 67 

Joint, open carpal 100 

Joint, open fetlock 110 

Joint, pastern proximal Inter- 

phalangeal 129 

Joint, shoulder 55 

Joint, stifle, open 220 

Joint, tarsal, open 229 



INDEX 



L 

Lameness, hip 195 

Lameness, mixed 49 

Lameness in the fore leg 55 

Lameness in the hind leg 185 

Lameness, shoulder 61 

Lameness, supporting-leg 49 

Lameness, swinging-leg 49 

Laminitis 160 

Laminitis, acute 162 

Laminitis, chronic 164 

Lateral cartilage, infectious in- 
flammation of the. 174 

Lateral cartilages, ossification 

of 155 

Ligaments, affections of 20 

Ligament, capsular 190 

Ligaments, collateral 190 

Ligament, cotyloid 185 

Ligaments, crucial 188 

Ligaments, dorsal 190 

Ligaments, femeropatella 188 

Ligament, medial 190 

Ligaments, mesial tarsal, 

sprains of the 232 

Ligaments of pastern proximal 
interphalangeal joint, inflam- 
mation of 129 

Ligaments, patellar 188 

Ligaments, plantar 190 

Ligament, pubiofemoral 185 

Ligament, superior check 58 

Ligament, suspensory, rupture 

of 146 

Ligaments, volar 129 

Ligament, volar-carpal or an- 
nular 58 

Ligation of the saphenous vein. .246 

Line firing for bog spavin 246 

Longitudinal fractures 18 

Lumbosacral plexus 204 

Luxation of the carpal bones.... 96 

Luxation of the femur 201 

Luxation of fetlock joint 125 

Luxation of the patella 213 



Luxation cf the patella, out- 
ward 215 

Luxation of the patella, up- 
ward 214 

Luxation of scapulohumeral 

joint 67 

Luxations 21 

Luxations, fixed 21 

Luxations, temporary 21 

Lymph vessels and glands, af- 
fections of 32 

Lymphangitis 32 

Lymphangitis, infectious 257 

Lymphangitis, non-infectious..260 

M 

Medial ligament 190 

Median neurectomy 124 

Mesial tarsal ligaments, sprains 

of the 232 

Metacarpophalangeal articula- 
tion 58 

Metacarpus, fracture of the 106 

Metastatic arthritis 25 

Mixed lameness 49 

Momentary patellar disarticula- 
tion 213 

Movements, passive 47 

Multiple fractures 18 

Multiple longitudinal fractures.. 19 

Muscles, affections of 28 

Muscle, antea-spinatus 65 

Muscle, anterior digital ex- 
tensor 193 

Muscle, biceps brachii 58 

Muscle, caput 71 

Muscle, gluteus medium. ...192, 203 

Muscle, infraspinatus 65 

Muscle, peroneus tertius 193 

Muscle, postea-spinatus 65 

Muscles, quadriceps 193 

Muscles, quadriceps, atrophy 

of the 205 

Muscle, subscapularis 65 

Muscle, supraspinatus 65 



LAMENESS OF THE HORSE 



Muscle, tibialis anticus 193 

Muscle, triceps brachii 58 

Myalgia 195 

N 

Nail punctures 178 

Navicular disease 157 

Nerves, affections of 30 

Nerve, femoral, paralysis of 

the 204 

Nerve, obturator, paralysis of 

the 206 

Nerve, sciatic, paralysis of 

the 20S 

Nerve, (suprascapular) par- 
alysis of the 75 

Non-infectious lymphangitis ..260 

Non-infectious bursitis 28 

Neurectomy, Bossi's double 

tarsal 242 

Neurectomy, median 124 

Neurectomy, plantar 124 

O 

Oblique fractures 18 

Observing character of gait 48 

Obturator nerve, paralysis of 

the 206 

Occurrence, general discussion 

of 15 

Omphalophlebitis 25 

Open carpal joint 100 

Open fetlock joint 110 

Open joint 67 

Open sheath of flexors of pha- 
langes 124 

Open stifle joint 220 

Open tarsal joint 229 

Os corona 60 

Ossification of cartilages of the 

third phalanx 155 

Ossification of the lateral 

cartilages 155 

Os innominatum 196 

Os suffraginis 59 



Osteitis, rarefying 16 

Outward luxation of the pa- 
tella 215 

P 

Palpption, examination by 43 

Paralvsis, brachial 77 

Paralysis of the femoral nerve..204 

PRrab'sis of the hind leg 204 

Paralysis of the obturator 

nerve 206 

Paralvsis of the sciatic nerve. ...208 
Paralysis of the suprascapular 

nerve 75 

Paralysis, radial 77 

Paronychia 170 

Passive movements 47 

Pastern proximal interpha- 

langeal joint, inflammation of 

ligaments of 129 

Patella 188 

Patella, fracture of the 212 

Patella, luxation of the 213 

Patella, outward luxation of 

the 215 

Patella, upward luxation of 

the 214 

Patellar disarticulation, fixed... .213 
Patellar disarticulation, mo- 
mentary 213 

Patellar ligaments 188 

Pelvic bones, fractures of the..l96 
Pelvic limbs, anatomo-physio- 

logical consideration of the.. ..185 

Penetrative wounds 85 

Periarticular ringbone 122 

Peroneus tertius muscle 193 

Phalangeal exostosis 118 

Phalanges, fracture of first and 

second 131 

Phalanges, open sheath of 

flexors of 124 

Phalanx, first 59 

Phalanx, second 60 

Phalanx, third, ossification of 

cartilages of 155 



1 



INDEX 



Plantar ligaments 190 

Plantar neurectomy 124 

Polyarthritis 25 

Postea-spinatus muscle 65 

Principles, diagnostic 37 

Proximal sesamoid bones, in- 
flammation of 127 

Proximal sesamoids, fracture 

of 128 

Publofemoral ligament 185 

Pubis, fracture of the 197 

Punctures, nail 178 

Q 

Quadriceps muscles 193 

Quadriceps muscles, atrophy of 

the 205 

Quittor 174 

Quittor, injection of fluids for.. ..177 

R 

R8c^''itic ringbone 122 

RafMal paralysis 77 

Radius, fracture of the 87 

Rarefying osteitis 16 

Rheumatic arthritis 26 

Rheumatism 196 

Ringbone 118 

Ringbone, articular 121 

Ringbone, periarticular 122 

Ringbone, rachitic 122 

Ringbone, traumatic 122 

Ringbone treated by firing 123 

Roberts shoe for bracing the 

fetlock 181 

Rupture of the extensor pedis. .145 
Rupture of flexor tendons and 

suspensory ligament 146 

Rupture of long digital ex- 
tensor 253 

Rupture of the tendo archillis..224 

S 

Saphenous vein, ligation of 
the 246 



Scapula, fracture of the 62 

Scapulohumeral articulation .... 55 
Scapulohumeral joint, injuries 

to 66 

Scapulohumeral joint, luxation 

of 67 

Scapulohumeral joint, wounds 

of 67 

Scapulohumeral arthritis 65 

Sciatica 208 

Sciatic nerve, paralysis of the. .208 

Second phalanx 60 

Sesamoid bones 59 

Sesamoid, third, inflammation 

of the 157 

Sesamoids, proximal, fracture 

of 128 

Sesamoiditis 127 

Setons 75 

Sheath of flexors of phalanges, 

open 124 

Sheath (tarsal) of the deep 

digital flexor, distension of 

the 246 

Shoe for dropped soles 169 

Shoeing for interfering 256 

Shoulder atrophy 73 

Shoulder joint 55 

Shoulder lameness 61 

Simple fractures 17 

Simple transverse fractures.... 18 

Soles, dropped, shoe for 169 

Spavin, bog 242 

Spavin, bone 235 

Spavin, dry 225 

Spavin test 239 

Special methods of examina- 
tion 53 

Sprains of the mesial tarsal 

ligaments 232 

Sprains, tarsal 232 

Splints 107 

Spring-halt 225 

Stifle, dropped 205 

Stifle joint, open 220 



LAMENESS OF THE HORSE 



Strangles 25 

Streptococcus equi 25 

String-halt 225 

Subject, attitude of the.. 41 

Subscapularis muscle 65 

Supporting-leg-lameness 49 

Suprascapular nerve, paralysis 

of the 'J'5 

Supraspinatus muscle 65 

Superficial digital flexor 194 

Superior check ligament 58 

Suspensory ligament, rupture 

of 146 

Sweeny ''3 

Swinging-leg-lameness 49 

Swinney 73 

Swinney, hip 205 

Synovial distension of tendon 

sheaths - 104 

Synovitis 25 

Synovitis, infectious 124 

T 

Tarsal arthritis 225 

Tarsal bones 190 

Tarsal joint capsule, distension 

of the 242 

Tarsal joint, open 229 

Tarsal sheath of the deep 
digital flexor, distension of 

the 246 

Tarsal sprains 232 

Tarsus 192 

Temporary luxations 21 

Tendinitis 135 

Tendinitis, acute 135 

Tendinitis, chronic 137 

Tendo achillis, rupture and 

wounds of the 224 

Tendon, deep flexor, inflamma- 
tion of the 157 

Tendon, deep flexor (per- 

forans) 60 

Tendon, extensor, rupture of..l45 



Tendon, flexor, rupture of 146 

Tendons of foals, contracted.... 143 
Tendon sheaths, synovial dis- 
tension of 104 

Tendons, affections of 28 

Tendons, flexor, contraction of 

the 137 

Tendons, flexor, inflammation 

of the 135 

Tendo-synovitis, gluteal 203 

Tenotomy, cunean 242 

Tensor fascia lata 192 

Test, spavin 239 

Testers, hoof 53 

Thecae, affections of 27 

Thecitis 27, 104 

Thecitis in the fetlock region....l50 

Thoroughpin 246 

Thoroughpin, aspiration-and-in- 

jection treatment of 250 

Thrombosis, iliac 209 

Thrombosis of the brachial 

artery 81 

Tibia 188 

Tibia, fracture of the 222 

Tibial tarsal bone, fracture of 

the 230 

Tibialis anticus muscle 193 

Tibioastragular joint, disten- 
sion of the 242 

Transverse fractures 18 

Traumatic arthritis 22 

Traumatic ringbone ..'. 122 

Treatment of bog spavin by 

aspiration and injection 244 

Treatment of capped hock by 

aspiration and injection 252 

Treatment of ringbone by fir- 
ing - 123 

Treatment of thoroughpin by 

aspiration and injection 250 

Triceps bracbii 58 

Triceps brachii. contusions of.. 71 
Triceps extensor brachii 71 



I 



INDEX 



Trochanteric bursa, inflamma- 
tion of the 204 

True crepitation 47 

U 

Ulna, fracture of the 86 

Ulnaris lateralis 94 

Upward luxation of the patella.. 214 

V 

Vein, saphenous, ligation of 

the 246 

Vesication for bog spavin 246 

Vessignon cheville 246 

Visual examination 39 

Volar-carpal ligament 58 



Volar ligaments 129 

W 

Wounds, calk 170 

Wounds, contusive 85 

Wounds from Interfering 255 

Wounds of anterior brachial 

region 90 

Wounds of coronary region 170 

Wounds of scapulohumeral 

joint 67 

Wounds of tendo achillis 224 

Wounds, penetrative 85 

X 

X-ray diagnosis 179 



AUTHORITIES CITED 



Almy, J 

141, 200, 202, 208, 212, 216, 214, 233 

Bassi 215 

Bauman, S. H 197 

Bell, Roscoe R 69 

Benard '216 

Berns, Geo. H 77, 218 

Bouley 225 

Bourdelle 147 

Cadiot, P. J....78, 141, 200, 202, 208, 

212, 214, 216, 223, 225, 233, 245, 250 

Campbell, D. M 162, 166, 167 

Castagne 84 

Cochran, David W 169, 170 

Diekerhoff 237 

Dollar, Jno. A. W 68, 198 

Eberlein 237 

Fisher, Carl W 236 

Frost, J. N 113 

Frost, R. F 128 

Greaves, Thomas 157 

Hoare, E. Wallis 25, 211, 230 

Hughes, Joseph 176, 221 

Hutyra and Marek 205 

Law, James 33 



Leblanc 223 

Liautard, A 84, 199, 238 

Lusk, Wm. V 203 

McDonough, James 237 

Merillat, Edward 210 

Merillat, L. A 80, 96, 175, 210 

Millar, Thomas 145 

Muller, H 119, 156, 211, 222 

Montane 147 

Moore, R. C 162 

Roberts, G. H 181 

Schumacher 215 

Scott, John 208 

Seeley, J. T 176 

Sisson, Septimus 129, 204, 220 

Smith, F., Major General 56, 

60, 155, 188, 194 

Strangeways 193 

Taylor, Henry 71 

Thompson, H 83, 87 

Trickett, A 253 

Udall, D. H 236 

Uhlrich 224 

Walters, Wilfred 83, 97 

Williams, W. L 217, 236 



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